[Management of non malignant papillary lesions diagnosed on percutaneous biopsy]. / Les tumeurs papillaires non malignes du sein: quelle prise en charge après diagnostic percutané?

PURPOSE: To assess the reliability of percutaneous breast biopsies in diagnosing and managing non malignant papillary lesions and determine if subsequent excision must be systematic. MATERIALS AND METHODS. Retrospective review of 2233 breast biopsies over a 43 months period (September 2001 to March 2005): sonographically guided core biopsies (n = 836), ultrasound (n = 346) or stereotactic (n:1051) guided vacuum biopsies. 86 non malignant papillary tumors were diagnosed (core biopsy:28, US:38 and stereotactic guided vacuum biopsy:20). A larger sample was systematic after core biopsy: lumpectomy (n = 19) or vacuum biopsy (n = 9). Surgical excision followed vacuum biopsy (n = 18) in case of atypia or sampling excision. Alternatively, yearly follow-up was advised (n = 40). Correlation with surgical findings (n = 37) or mammographic follow-up (n = 49) is presented. The influence of various factors on the risk of underestimation was analysed. RESULTS: Surgical resection revealed an underestimation of 5/37 (13.5%): 4/19 with core- and 1/18 with vacuum-assisted biopsy corresponding to 4 low grade ductal carcinoma in situ and a microinvasive ductal carcinoma in situ. It was higher for core biopsies and related to age and size: higher when women<50 years and when radiological image>1 cm. The influence of the other factors was not significant. Of the 9 non operated papillomas after core biopsy, vacuum biopsy revealed an additional underestimation (low-grade ductal carcinoma in situ). Of the 49 papillary lesions that were not surgically biopsied, 40 were monitored at 2-42 months (average: 19 months). No carcinoma was detected during this follow-up. CONCLUSION: Percutaneous biopsy is an accurate technique in managing papillary tumors. A larger histologic specimen is necessary after core biopsy. Vacuum biopsy is an attractive alternative to surgery for smaller papillomas (<1 cm), but in spite of nonsignificant results we advise subsequent excision in case of multiple papillomas, atypia or residual tumor.

[Ultrasound-guided vacuum-assisted biopsy: review of 382 cases]. / Macrobiopsies assistées par le vide sous guidage échographique: à propos de 382 cas.

PURPOSE: To evaluate the use of US-guided vacuum biopsy for diagnosis and treatment of probably benign breast masses. MATERIALS AND METHOD: Retrospective review of 382 US guided vacuum biopsies over a 44 months period (september 2001 to may 2005) with the 11-g handheld mammotome. A total of 308 benign tumors, 59 borderline lesions and 15 carcinomas were diagnosed. The average number of specimens is 13.1 (3-37). Surgical resection has been systematic for carcinomas and selective for papillomas. Surgical correlation (n:35) or mammographic follow-up (n:347) are presented. RESULTS: Complete removal occurred in 371/382 (97.1%) immediately after biopsy and 337/382 (88.2%) after one month: 138/142 (93.7%) for fibroadenomas and 52/53 (98.1%) papillomas less than 15 mm. Open surgical biopsy was carried out for 35 patients on the basis of incomplete removal (3 cases) or histologic findings (8 invasive carcinomas, 7 ductal carcinoma in situ, 3 atypical ductal hyperplasia, 1 fibrocystic changes with atypia and 11 papillomas). No lesion was under-diagnosed and the rate of avoided surgery was 94.5%. Of the 347 lesions that were not surgically biopsied (42 borderline lesions and 305 benign lesions), 337 were monitored at 1-43 months (average: 20 months, > or =24 months: 57 patients). Ten underwent additional biopsy but no missed cancer was detected. Patients tolerance was good or very good in 83%, and the complication rate was 1.3%. CONCLUSION: US-guided vacuum biopsy is an accurate and well tolerated technique. It is an alternative to surgery for masses less than 15 mm including fibroadenomas and papillomas or in patients with imaging-histologic discordance at core biopsy.

[Pap test: liquid-based--thin-layer. A new method: results]. / Frottis de dépistage : recueil en suspension--étalement en couche mince. Méthode novatrice : analyse des résultats.

OBJECTIVES: Evaluation of the thin-layer technique we have developed. PATIENTS AND METHOD: An adequate shaking, a calibration and a centrifugation in liquid phase are the essential and specific stages of this technique. More than 160 000 samples were prepared according to this methodology in eight years. RESULTS: The immediate profit of the technique is the increase of the number of interpretable samples: 99.9%. First years: net increase of the lesion detection rate in comparison with conventional cervical smear. 1.7 versus 0.9% for the low-grade lesions; 1.0 versus 0.4% for the high-grade lesions. After three years the detection rate of low-grade lesions remained high: 1.7% while the ASCUS/AGUS and high-grade lesions decreased to reach, respectively, 1.1 and 0.4%. DISCUSSION AND CONCLUSION: The quality of the thin-layer preparation, the best approach of the endocervical pathology, and the possibility to identify rare events, allowed us at first to increase detection of lesions. After three years of "picking up" of lesions forgotten by conventional cervical smear, the rate of high-grade lesions stabilised in 0.4%. Thus, it is advisable to take into account the notion of time as for the estimate of the lesion rate when using thin-layer technique compared with that of conventional cervical smear.

[Underestimation of breast carcinoma with 11-gauge stereotactically guided directional vacuum-assisted biopsy]. / Sous-estimation du cancer du sein par les macrobiopsies stéréotaxiques 11-gauge assistées par le vide.

PURPOSE: To assess the reliability of vacuum-assisted biopsy in diagnosing and managing atypical ductal hyperplasia and ductal carcinoma in situ of the breast. MATERIALS AND METHOD: Retrospective review of 2130 stereotactic large-core biopsies in 1638 patients over a 40 month period (January 2000 to May 2003) using the mammotome 11-gauge and a dedicated Fischer table. A total of 135 cases of atypical ductal hyperplasia and 322 cases of ductal carcinoma in situ were diagnosed. The average number of cores was 18 (5-64). Surgical resection was systematic for carcinomas and selective for atypical ductal hyperplasia. Correlation with surgical findings (n:356) or mammographic follow-up (n:98) is presented. The influence of various factors on the risk of underestimation was analyzed. RESULTS: Resection revealed an underestimation of 10/37 (27%) for atypical ductal hyperplasia. It was lower (9%) when the radiological lesion had completely disappeared. Underestimation of ductal carcinoma in situ was 12/319 (3.8%). It was higher for masses, high-grade lesions or with micro-infiltration, or in the case where the peripheral edge was affected. Of the 98 atypical ductal hyperplasia that were not surgically biopsied, 81 were monitored at 9-42 months (average: 29 months). Sixteen underwent repeat biopsy: two infiltrating lobular carcinomas were detected in the same area. CONCLUSION: Underestimation of atypical ductal hyperplasia was high, justifying systematic surgical resection. Underestimation of ductal carcinoma in situ and its practical consequences are not significant with the extension of sentinel lymphadenectomy to the wide high-grade lesions or with micro-infiltration.

[Bladder tumors: prognostic value of surface antigens and carcinoembryonic antigens. A retrospective study]. / Tumeurs de vessie: intérêt pronostique des antigènes de surface et de l'antigène carcino-embryonnaire. Etude rétrospective.

Seven patients presenting with recurrent diffuse, non-infiltrating tumors of the bladder were treated for several years by repeated endo-urethral resection, because radical exeresis was not possible. Each operative specimen was subjected to examination of the ABH blood-group antigens, pneumo-14 precursor, and carcino-embryonic antigens. The authors emphasize the prognostic interest of such studies.

A comparative study of DNA content as measured by flow cytometry and image analysis in 1864 specimens.

Both flow cytometry (FCM) and image cytometry (ICM) were used to assess the DNA content of 1864 lesions (benign and malignant tumors, dysplasias, dystrophies and normal tissue). In total there were 1274 cases of bladder washings and 590 fresh solid tumor specimens. Of the total number of specimens, 1737 (93.2%) were satisfactorily assessed by ICM and 1424 (76.4%) by FCM. In only 100 (5.4%) cases was the DNA content unable to be assessed by either method. When bladder washings were excluded, 99.5% of samples could be evaluated by one method or the other. Concomitant determinations with both technologies were made in 1397 cases. When comparing all evaluable cases, concordance between the ploidy measurements of FCM and ICM was 92.8% (1297 concordant cases out of 1397). When bladder washings were excluded and only solid tumors considered, the concordance was 96.1% (545 concordant cases out of 567). From the experience of applying ICM and FCM to the 1864 lesions the technical limitations of each method became evident, specifically the problems of doubtful DNA diploidy and doubtful DNA aneuploidy. When there were 'doubtful' ploidy findings, the cause was generally found to be morphologic alterations of the nuclei or differences in staining procedures employed, and often the complementary use of both FCM and ICM provided ploidy clarification in questionable cases.

[Urothelial inverse papilloma. Review of the literature (appropos of 2 cases: 1 vesical, the other urethral)]. / Papillome inversé urothélial. Revue de la littérature (a propos de 2 cas : l'un vésical, l'autre uréthral).

The authors report two cases of urothelial inverse papilloma and review the 94 observations in the published literature. Some fundamental features of the condition are outlined: 1) DEFINITION: paramalpighian papillary tumor which spreads towards the chorium but does not invade it, and lies under the intact urothelium which is folded towards the lumen of the urinary tract, 2) Site: usually cervicotrigonal but may be urethral; 3) Evolution: usually benign but sometimes recurrent; 4) Histogenesis: abnormal proliferation of Von Brunn's islets. 5) Association: possible with bladder carcinomas.

Plasma cell acid phosphatase, a discriminative test for benign and malignant monoclonal gammopathies.

Acid phosphatase activity estimated cytochemically is markedly increased in myeloma plasma cells compared to that found in normal plasma cells, polyclonal plasma-cytoses and most interestingly in the non-myelomatous monoclonal dysglobulinaemias. In the differential diagnosis of this last group the test has a useful role.

Improvement of the demonstration of A, B, H surface antigens in bladder tumors by a simple immunofluorescence technique.

The presence of A, B and H blood group antigens in paraffin-embedded tissue sections was demonstrated with a routine direct and indirect immunofluorescence technique. Natural and human antisera were used for 102 biopsy specimens of the various blood groups, including normal mucosa and vesical tumors. This technique allows a more precise description than the specific red cell adherence reaction of the differentiation pattern of the tumor itself and of the surrounding and distant mucosa. It may prove useful in suggesting a revised classification system, with more diagnostic and prognostic significance.

[Blood group ABO (H) cell surface antigens in bladder tumours invading the chorion. Prognostic value of their determination by immunofluorescence. Retrospective study of one hundred and twenty-five cases]. / Les antigènes de groupe sanguin ABO (H), dans les tumeurs de vessie infiltrant le chorion. Valeur pronostique de leur détermination par immunofluorescence. Etude rétrospective de cent vingt-cinq cas.

The authors have studied 125 stage A bladder tumours with a follow-up period of at least 5 years. The ABH cell surface antigens were collected by a double-layer immunofluorescence technique which has already been described. All the cross sections were read by the same pathologist who knew nothing about the clinical developments. The results were divided into 3 groups : (I) all the tumour cells had retained their surface antigens. (II) Only some cells had retained surface antigens. (III) All cells were negative. Study of the development of the 3 groups shows that : in group I, all the patients (11) are alive 5 years later, and only one has presented with a lesion evolving towards infiltration. In group II (32 patients), only 38 p. cent of the patients are still living 5 years later, and 65 p. cent developed towards muscular infiltration. In group III (77 patients), 27 p. cent are alive after 5 years and 80 p. cent have developed towards muscular infiltration. Homogeneous retention of the surface antigens would therefore seem to be a favourable factor in the prognosis, even in the case of a tumour which has already infiltrated the chorion. The significance of the loss of surface antigens is less clear-cut, but is on the whole adverse. The significance would, however, probably be enhanced by study of the mucosa distal from the lesion, and by marking the substances which determine the blood groups.