Current perspectives on Gleason grading of prostate cancer.

The 5-tier Gleason grading system for prostate cancer, introduced in 1966, has been proven to be one of the main independent predictors of prostate cancer outcome. This review addresses interobserver concordance in Gleason grading; the persistence of grading discrepancies with frequent upgrading from the biopsy to the prostatectomy specimen; the 2005 International Society of Urologic Pathologists' modifications to Gleason grading; the impact of this modified grading on grade migration and outcome prediction; and molecular correlates of cancer morphology. Data from the most recent years are emphasized.

Neoplasia lobular e seu significado à biópsia percutânea / Lobular neoplasia - the significance of percutaneous biopsy findings

Ao longo dos últimos anos, drásticas mudanças ocorreram na incidência, no diagnóstico, na classificação,na natureza e no tratamento das doenças mamárias, particularmente em relação aoscarcinomas in situ, e ao emprego de biópsias percutâneas para avaliação das lesões detectadas àmamografia. A maioria dos consensos e das recomendações, quando o diagnóstico de carcinomaductal in situ (CDIS) é feito pela biópsia por agulha grossa, é prosseguir a investigação com a biópsiaexcisional. Entretanto, o significado da neoplasia lobular diagnosticada por meio de biópsiaestereotáxica representa novo campo de debate.

Dramatic changes occurred in the incidence, diagnosis, classification, nature, and management of thebreast diseases during the last years, particularly between the in situ carcinomas and the role of percutaneousbiopsies used for the mammographic lesions. The vast majority of consensus recommends excisionalbiopsy following a result of ductal in situ carcinoma obtained by core biopsies. But there are a lot of questionswhen lobular carcinoma is encountered after stereotaxis biopsies.

Breast core biopsy reporting categories--An internal validation in a series of 3054 consecutive lesions.

We reviewed 3226 consecutive core biopsies (CBs) of 3054 mammographically detected breast lesions performed at our Centre from November 1993 to June 2003. CB diagnoses, classified according to the Non-operative Diagnosis Subgroup of the British National Health Service Breast Cancer Screening Programme (NHSBSP), were B5 (37.1%), B4 (0.5%), B3 (7.6%), B2 (50.9%) and B1 (3.9%). It was necessary to repeat the procedure in 172 cases (5.3%). The values for absolute sensitivity and specificity are 90.8% and 83.8%, respectively. The positive predictive value for categories B4 and B5 is 100%, with no false-positives. The positive predictive value for category B3 is 16.3%. The negative predictive value for B2 category is 97.2%, with a false-negative rate of 3.5%. In conclusion, this system of analysis has enabled us to confirm that our CB results surpass the minimum recommended standards proposed by the NHSBSP.

Excision biopsy findings of patients with breast needle core biopsies reported as suspicious of malignancy (B4) or lesion of uncertain malignant potential (B3).

AIMS: The UK National Health Service Breast Screening Programme has proposed five categories for reporting breast needle core biopsies. The majority of cores are reported as benign (B1), normal (B2) or malignant (B5). The predictive value of the two borderline categories suspicious of malignancy (B4) and lesion of uncertain malignant potential (B3) was studied. METHODS AND RESULTS: Over a 2-year period a total of 3822 breast needle core biopsies were performed, with 2997 from symptomatic patients and 825 from women undergoing mammographic screening, including 43 B4 reports (40 patients) and 120 B3 reports (116 lesions in 115 patients). The frequencies of B4 (2.5% versus 0.7%) and B3 cores (7.3% versus 2.0%) were both higher in screening than in symptomatic patients. B4 was most commonly used for small fragments of atypical cells separate from the main core or focal atypical intraductal proliferations. The criteria for calling a core B3 were: atypical intraductal epithelial proliferations (including foci that in excision specimens would be classified as atypical ductal hyperplasia), lobular neoplasia, radial scar, papillary lesion, fibroepithelial lesion with cellular stroma and spindle cell proliferations. Excision biopsies were performed in 39 patients with B4 core and 96 with B3 core. Invasive carcinoma or ductal carcinoma in situ was seen in 33 of the patients with B4 (85%) and in 29 of those with B3 cores (25%). Some categories of B3 core were associated with a higher rate of malignancy (40% for atypical intraductal epithelial proliferations and 46% for lobular neoplasia). CONCLUSIONS: The positive predictive value for carcinoma is high following a B4 core (86%). The lesion should be excised, but definitive cancer treatment is not appropriate. In some cases a definite diagnosis of malignancy can be made on repeat core. The B3 group is more heterogeneous and has a lower rate of malignancy on further biopsy (25%). The majority of B3 lesions require excision. All these patients should be discussed at multidisciplinary meetings.

Sistemas de graduaçäo para carcinoma de mama: estudo comparativo da concordância cito-histológica / Grading systems for breast carcinoma: comparative study of cytohistological agreement

Objetivos: avaliar a concordância das classificações citológicas de graduaçäo tumoral e nuclear nos esfregaços de punçäo aspirativa por agulha fina (PAAF) de carcinoma de mama com os métodos utilizados nos espécimes histológicos e compará-los para identificar aqueles que apresentam melhores resultados. Métodos: a avaliaçäo da concordância cito-histológica foi realizada em estudo retrospectivo de 50 casos de PAAF de carcinoma ductal invasivo de mama, confirmados histologicamente, aplicando-se de forma comparativa cinco sistemas de graduaçäo. As classificações foram separadas segundo critérios de graduaçäo tumoral (critérios nucleares e arquiteturais - sistemas de Mouriquand e de Guilford) e nuclear (sistemas de Black modificado por Fisher - BM, de Black simplificado - BS e de Hunt). As classificações utilizadas na histologia foram os sistemas de graduaçäo de Scarff-Bloom-Richardson modificado por Elston (SBR modificado), para avaliaçäo tumoral, e o de BM, para avaliaçäo nuclear. Resultados: os sistemas de graduaçäo citológica que apresentaram maior concordância foram os sistemas de BM (K=0,358) e BS (K=0,302), baseados em critérios nucleares (anisonucleose, tamanho, mitose e cromatina). Dentre os sistemas de graduaçäo citológica que apresentam critérios nucleares e arquiteturais, a classificaçäo de Guilford demonstrou maior concordância (K=0,260), possivelmente pelo número maior de variáveis utilizadas, possibilitando menor margem de erro. Conclusäo: no presente estudo, estes métodos mostraram-se regulares como sistemas de graduaçäo citológica

Indicaciones de las punciones controladas con ecografía y calidad de las muestras / Indications for ultrasonographically guided punction and quality of the specimens obtained

Las punciones mamarias bajo control ecoguiado prolongan el examen senológico. Los autores recuerdan las diferentes técnicas que permiten efectuar estos gestos con el máximo de eficacia al mismo tiempo que se limitan los riesgos. Las indicaciones actuales de las punciones con aguja fina, de las microbiopsias y de las macrobiopsias son precisadas (AU)

[Does the core biopsy of solid liver lesions permit an exact histological classification? Results of a prospective study under routine clinical conditions]. / Erlaubt die Stanzbiopsie solider Leberherde eine exakte histologische Klassifizierung? Ergebnisse einer prospektiven Untersuchung unter klinischen Routinebedingungen.

PURPOSE: The aim of this prospective study was to answer the question to what extent percutaneous core-cut biopsy of solid lesions of the liver can permit (sub-)classification under routine conditions. MATERIAL AND METHODS: Subject of this study were 80 percutaneous core-cut biopsies of solid liver lesions in 75 patients. The biopsies were done consecutively under routine conditions by 10 different radiologists with Tru-Cut-needles and a biopsy gun with sonographic (n = 73) or CT (n = 7) guidance. After receiving the histological analysis, the radiologists then prospectively divided the biopsies into "valid" und "unclear" using clinical and radiologic data of the respective patient. The results were verified by a second biopsy, follow-up or surgery. RESULTS: 80% of all histological analyses were rated as "valid", 20% as "unclear". The accuracy of the "valid" reports in respect of ranking was 95% and 90% for the accurate tumour classification. These values were reduced to 81.3% and 74%, respectively, with regard to the total number of cases. The negative predictive value was reduced from 78% to 51.7%. CONCLUSION: Core-cut biopsy of solid liver lesions guided by imaging yields good results even under routine conditions as long as all histological reports have been correlated with imaging and clinical informations.

Surgical pathology examination of lymph nodes. Practice survey by American Society of Clinical Pathologists.

The American Society of Clinical Pathologists surveyed 363 pathologists to determine practices used in processing and reporting lymph node specimens submitted for surgical pathology examination. This topic is of interest because lymph nodes are some of the more common organs biopsied for diagnostic purposes and the constant change in and diversity of classification systems in the past 30 years. The definition of newly recognized entities and the use of sophisticated diagnostic tools also have made it difficult for there to be a solid consensus of pathologists in diagnosing lymphoproliferative disorders for correlation with clinical behavior and response to therapy. The survey, conducted in November 1992, contained 79 questions. Participants were selected to represent a variety of practice settings and 179 (49%) responses were received.

Coding and reimbursement of primary care biopsy and destruction procedures.

Current medical practice requires physicians to accurately report services provided to patients. Billing for destruction of benign and malignant lesions and for surgical, needle, and endoscopic biopsy procedures involves the selection of specific 1992 Current Procedural Terminology (CPT) codes. Payment for these procedures by third-party payers often requires the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding for neoplastic lesions. This review explains the proper codes to use in identifying common biopsy and destruction procedures performed by primary care physicians. The Health Care Financing Administration's relative value units and one state's published Medicaid payment rates are included for each procedure code. Instructions for selecting site-specific biopsy and destruction codes are provided.