Interpretation of Nondiagnostic Vulvar Biopsies.

OBJECTIVE: The aim of the study was to assess clinical and histopathologic characteristics of symptomatic women who underwent a nondiagnostic biopsy of the inner vulva. MATERIALS AND METHODS: Consecutive nondiagnostic biopsies from medial labia minora, posterior fourchette, and vestibule obtained from symptomatic women between 2011 and 2015 were reviewed for this retrospective histopathologic case series. Histopathologic assessment included site, basal layer appearance, lymphocytic infiltrate, and presence of fibrosis or sclerosis. Examination findings, treatment, initial impression, and final clinical diagnosis were recorded. Descriptive statistics were performed; clinical and histopathologic characteristics were compared with Fisher exact test. RESULTS: There were 85 cases; mean age was 53 years. Most women presented with painful erythema and underwent biopsy to confirm (30, 35%) or exclude (43, 51%) lichen planus. After clinical follow-up and histopathologic review, most cases had persistent diagnostic discordance. Final clinical diagnoses were available in 70 women: lichen planus in 27 (38%), vulvodynia in 15 (21%), and the other 28 (40%) had LS (8), plasma cell vulvitis (5), psoriasis (4), dermatitis (4), candidosis (3), estrogen deficiency (3), and aphthosis (1). Histopathologic review highlighted the difficulty in distinguishing mucosa-associated lymphoid tissue from an inflammatory infiltrate in 23 (27%) of cases. Compared with other sites, biopsies from the mucocutaneous junction were more likely to be associated with a positive culture for Candida albicans. CONCLUSIONS: Nondiagnostic biopsies from the inner vulva should prompt thoughtful multidisciplinary review, but more research is required to resolve the problem of clinicopathologic discordance through better understanding of vulvar histology and pathophysiology.

Intra-operative ultrasound versus wire-guided localization in the surgical management of non-palpable breast cancer.

BACKGROUND: Non-palpable breast lesions require some method of localization when performing breast conserving surgery (BCS). Despite the advent of newer techniques, ultrasound (US) and wire-guided localization (WGL) remain the most popular approaches. OBJECTIVE: We aim to compare the positive margin rate of US versus WGL in the excision of breast lesions. METHODS: Data were collected from the Clinical Access Portal. All patients who underwent US or WGL BCS were identified and consecutive data collected. Positive margins were evaluated using histopathology reports. Baseline demographics and specimen size data were also collected. RESULTS: A total of 198 patients were included in total over a three-year period. There was some evidence of an association of type of surgery with positive margin (OR=2.11, p=0.075) where a 2.11 fold increase in the odds of a positive margin was estimated for the US method relative to WGL, but this was not statistically significant at the 5% level. This effect decreased after adjusting for potential confounders (OR=1.81, p=0.34). CONCLUSIONS: This retrospective study of US versus WGL in BCS demonstrated no significant difference in the positive margin rate, although a trend was observed in favor of the WGL group. We have provided further evidence for the debate on the accuracy of US and WGL for non-palpable breast lesions. Available data remains sparse, and our results contradict the findings of other comparative studies.