648 research outputs found

    The comparison between cytological and histological grading of breast cancers in a Nigerian tertiary hospital

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    Background: Breast cancer is one of the most common cancers in Nigeria. The tumour grade is an important prognostic factor and is also important in treatment of patients. Fine needle aspiration cytology can be used as an initial diagnostic tool for planning definitive management. Grading of tumours on cytology further guides therapeutic decisions. The aim of this study is to compare the correlation between the cytological and histological grading of malignant breast lumps using the Robinson's cytological grading system and Nottingham histological grading system respectively. The Objectives are, to determine the age distribution of breast cancer in our environment, to grade breast cancers cytologically using the Robinson's cytological grading system and to grade breast cancers histologically using the Nottingham histological grading system.Methods: This was a one year prospective study that involved 30 patients who had malignant smears on fine needle aspiration cytology of their breast lump. These smears were graded using the Robinson's cytological grading system and compared with the Nottingham histological grading systems of same lumps obtained from either tissue biopsies or mastectomies.Results: The mean age of the study participants was 50.23±10.11 years with a range of 35-70 years. Most (56.7%) malignat smears were of cytologic grade 3. The histological grade was 2 in 16(53.3%) and 3 in 14(46.7%) of the same breast tissue samples. The grade 2 tumours had the highest concordance rate of 83.3%. The absolute concordance rate between Robinson's cytological and Nottingham histological grading system of breast cancers was 73.3%.Conclusion: The Robinson's cytological and Nottingham histological grading systems showed good correlation.Keywords: Breast Cancer, fine needle aspiration cytology, cytological grading, histological gradin

    Computer-aided Cytological Grading Systems for Fine Needle Aspiration Biopsies of Breast Cancer

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    According to the American Cancer Society, breast cancer is the world's most commonly diagnosed and deadliest form of cancer in women. A major determinant of the survival rate in breast cancer patients are the accuracy and speed of the malignancy grade determination. This thesis considers the classification problem related to determining the grade of a malignant tumor accurately and efficiently. A Fine Needle Aspiration (FNA) biopsy is a key mechanism for breast cancer diagnosis as well as for assigning grades to malignant cases. Carrying out a manual examination of FNA demands substantial work from the pathologist which may result in delays, human errors, and consequently lead to misclassified grades. In this context, the most common grading system for microscopic imaging for breast cancer is the Bloom and Richardson (BR) histological grading system which is based on the evaluation of tissues and cells. BR is not directly applicable to FNA biopsy slides due to distortion of tissue and even cell structures on the cytological slides. Therefore, in this thesis, to grade FNA images of breast cancer, instead of the BR grading scheme, six known cytological grading schemes, three newly proposed cytological grading schemes, and five grading systems based on convolutional neural networks were proposed to automatically determine the malignancy grade of breast cancer. First, considering traditional Machine Learning methods, six cytological grading systems (CA-CGSs) based on six cytological schemes used by pathologists for FNA biopsies of breast cancer were proposed to grade tumors. Each system was built using the cytological criteria as proposed in the original CGSs. The six considered cytological grading schemes in this thesis were Fisher's modification of Black's nuclear grading, Mouriquand's grading, Robinson's grading, Taniguchi et al's, Khan et al's and Howell's modification in mitosis count criteria. To fulfill this task, different sets of handcrafted features using customized image processing algorithms were extracted for classification purpose. The proposed systems were able efficiently to classify FNA slides into G2 (moderately malignant) or G3 (highly malignant) cases using traditional machine learning algorithms. Additionally, three new cytological grading systems were proposed by augmenting three of the original CGSs by adding the low magnification features. However, the systems were not sensitive enough with regards to G3 cases due to the low number of available data samples. Therefore, a data balancing was performed to improve the sensitivity for G3 cases. Consequently, in the second objective of this work, data sampling and RUSBoost methods were applied to the datasets to adjust the class distribution and boost the sensitivity performance of the proposed systems. This enabled a sensitivity improvement of up to 30% which highlights the significance of class balancing in the task of malignancy grading of breast cancer. Additionally, due to the considerable time and efforts required for handcrafted features-based cytological grading systems in order to achieve efficient feature engineering results, a deep learning (DL) approach was proposed to avoid the aforementioned challenges without compromising the grading accuracy. Thus, in this thesis, five different pre-trained convolutional neural network (CNN) models, namely GoogleNet Inception-v3, AlexNet, ResNet18, ResNet50, and ResNet101, combined with different techniques to deal with unbalanced data, were used to develop automated computer-aided cytological malignancy grading systems (CNN-CMGSs). According to the obtained results, the proposed CNN-CMGS based on GoogleNet Inception-v3 combined with the oversampling method provides the best accuracy performance for the problem at hand. The results demonstrated that the proposed CGSs are highly correlated since they share some of the cytological criteria. Further, the overall accuracy of the CGSs is roughly the same and overall, the handcrafted features-based CGSs performed best even in the absence of class distribution rebalancing. Overall, for case classification, the best results were obtained for computer-aided CGSs based on the modified Khan et al.’s and Robinson’s schemes with accuracies of 97.77% and 97.28%, respectively. Meanwhile, for patient classification, the overall best results were obtained for computer-aided CGSs based on the modified Khan et al.’s and modified Fisher's schemes with accuracies of 96.50% and 95.71%, respectively. These results surpass previously reported results in the literature for computer-aided CGS based on BR histologic grading. Moreover, in clinical practice, Robinson’s typically has the best diagnostic accuracy with the highest reported experimental accuracy rate of 90%. Thus, the obtained results demonstrate that computer-aided breast cancer cytological grading systems using FNA can potentially achieve accuracy rates comparable to the more invasive histopathological BR-method

    Immunohistochemistry Applied to Breast Cytological Material

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    © 2022 S. Karger AG, Basel.Fine-needle aspiration biopsies (FNABs) of the breast are minimally invasive procedures enabling the diagnosis of suspicious breast lesions. Unfortunately, they are often perceived as inferior to core-needle biopsies, namely because they are supposedly unable to differentiate between high-grade ductal carcinoma in situ and invasive carcinoma or provide material for ancillary testing. Several studies have shown, however, that FNAB samples, when handled properly, are indeed capable of providing sufficient and adequate material for ancillary testing, namely immunocytochemistry (ICC). We reviewed the published literature regarding the use of ICC for both diagnostic and theranostic uses in the different types of cytological samples obtained from FNABs of the breast, including smears, liquid-based cytology samples, and cellblocks. We found that p63 and 34βE12 show promise in aiding in the differential diagnosis between in situ and invasive lesions and that most other diagnostic markers may be used as in tissue. Regarding theranostic ICC markers, results vary between publications, but with care, these can successfully be performed in cytological samples. Air-dried smears should be avoided, and cellblocks are overall more versatile than cytology slides, enabling the evaluation of not only hormonal receptors and HER2 by ICC, but also of Ki-67. Particular attention should be paid to fixation and antigen retrieval procedures in all cases. We recommend that laboratories without experience perform short validation runs before adopting these techniques into clinical practice.publishersversionpublishe

    Uloga citologije u otkrivanju i liječenju tumora dojke

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    Fine-needle aspiration cytology (FNAC) is an established, highly accurate, and cost-eff ective method for diagnosing lesions in the breast. The method is minimally invasive without unwanted side efect. FNAC forms part of the triple assessment of breast lesions and has a high accuracy and sensitivity in dedicated centres. Method as a part of triple assessment has provide its value in describing the fi ndings most accurately. The diagnostic impact depends on experience of the operator, quality of preparation and diagnostic skills of the cytopathologist. Inadequate sampling with FNAC is particulary seen in collagenous lesions and in submitt ed specimens sampled by physicians lacking experience with the FNAC procedure. The highest accuracy is achived at centres with multidisciplinary approach. The majority of European countries use similar reporting system for breast FNAC (C1-C5), in keeping with European guidelines for quality assurance in breast cancer screening and diagnosis. A clear reporting system ensures that an unequivocal cytological diagnosis of malignancy is reliable, and in cases where mammography/ultrasonography and clinical examination are in agreement with FNAC, frozen section examination is unnecessary. The issue of optimal sampling to obtain adequate cell material in suffi cient quantity is of paramount importance when assessing the accuracy of FNAC. The inadequate rates in FNAC from diff erent sources are lowest when FNAC is performed by a cytopathologist and highest when done by a non-cytopathologist. The multidisciplinary approach is necessary to amplify FNAC quality and to reduce its diagnostic limits. Only when this model of activity is not available, the role of FNAC is less eff ective and the addition of core biopsy (CB) to FNAC should be considered. CB as an alternative diagnostic modality should be used advisedly, in situations where it is more likely to yield diagnostic information, e.g., in the diagnosis of impalpable masses, microcalcifi cations or a clinically apparent malignancy where preoperative chemotherapy is planned. CB should not be used as a substitute for poor performance at FNAC. The methods are not mutually exclusive.Aspiracijska citologija tankom iglom (FNAC) je utemeljena, visoko pouzdana i jeftina metoda u dijagnostici lezija dojke. Metoda je minimalno invazivna bez neželjenih nuspojava. Sastavni je dio tzv. trojnog pristupa u dijagnostičkoj obradi lezija dojke, te u specijaliziranim centrima ima visoku pouzdanost i senzitivnost. Također je unutar trojnog pristupa dokazala svoju vrijednost mogućnošću da izrazito pouzdano okarakterizira promjene. Dijagnostički učinak ovisi o iskustvu liječnika koji izvodi postupak, kvaliteti obrade materijala te dijagnostičkim vještinama citopatologa. Neadekvatni uzorak se najčešće susreće u kolagenoznim lezijama,komplex sklerozirajućim promjenama te u oskudnosti primljenih materijalima od strane liječnika koji izvode punkciju, a nemaju dovoljno iskustva s procedurom. Najviša razina pouzdanosti postiže se u centrima s multidisciplinarnim pristupom. Većina europskih zemalja koristi isti sustav pisanja citoloških nalaza vezanih za dijagnostiku dojke (C1-C5), koristeći se smjernicama za osiguravanje kvalitete u probiru i dijagnostici karcinoma dojke. Jasni sustav pisanja nalaza time osigurava pouzdanost nedvojbene citološke dijagnoze maligniteta, te u slučajevima kada je ona u skladu s radiološkim nalazima (mamografijom/ultrazvukom), kao dio trojnog pristupa nije potrebna hitna, introperativna patohistološka dijagnostika. Optimalno prikupljanje materijala radi dobivanja adekvatno celularnog uzorka je od ključne važnosti za pouzdanost aspiracijske citologije ( FNA). Nivo neadekvatnog materijala je najniži kada postupak izvodi citopatolog, a najveći kada ga izvode liječnici drugih specijalnosti. Multidisciplinarni pristup je neophodan za povećanje kvalitete metode te za reduciranje njenih dijagnostičkih ograničenja. Samo u slučajevima kada ovakav model pristupa nije dostupan, uloga citologije (FNA) je manje učinkovita te se treba uzeti u obzir biopsija širokom iglom (CB). CB je alternativni dijagnostički modalitet, te se treba koristiti ciljano, u situacijama kada je izvjesnije da će omogućiti bolju dijagnostičku informaciju, npr. u slučajevima kada se radi o nepalpabilnim promjenama, mikrokalcifi katima, te u slučajevima klinički jasnog malignog procesa gdje se planira preoperativna kemoterapija. CB se ne treba koristiti kao alternativa slabo izvedenoj citološkoj punkciji, te se navedene dvije metode međusobno ne isključuju

    Added benefits of computer-assisted analysis of Hematoxylin-Eosin stained breast histopathological digital slides

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    This thesis aims at determining if computer-assisted analysis can be used to better understand pathologists’ perception of mitotic figures on Hematoxylin-Eosin (HE) stained breast histopathological digital slides. It also explores the feasibility of reproducible histologic nuclear atypia scoring by incorporating computer-assisted analysis to cytological scores given by a pathologist. In addition, this thesis investigates the possibility of computer-assisted diagnosis for categorizing HE breast images into different subtypes of cancer or benign masses. In the first study, a data set of 453 mitoses and 265 miscounted non-mitoses within breast cancer digital slides were considered. Different features were extracted from the objects in different channels of eight colour spaces. The findings from the first research study suggested that computer-aided image analysis can provide a better understanding of image-related features related to discrepancies among pathologists in recognition of mitoses. Two tasks done routinely by the pathologists are making diagnosis and grading the breast cancer. In the second study, a new tool for reproducible nuclear atypia scoring in breast cancer histological images was proposed. The third study proposed and tested MuDeRN (MUlti-category classification of breast histopathological image using DEep Residual Networks), which is a framework for classifying hematoxylin-eosin stained breast digital slides either as benign or cancer, and then categorizing cancer and benign cases into four different subtypes each. The studies indicated that computer-assisted analysis can aid in both nuclear grading (COMPASS) and breast cancer diagnosis (MuDeRN). The results could be used to improve current status of breast cancer prognosis estimation through reducing the inter-pathologist disagreement in counting mitotic figures and reproducible nuclear grading. It can also improve providing a second opinion to the pathologist for making a diagnosis

    Chemotherapy naive breast cancer: a correlation study between BD Cytorich™ Red cell blocks and formalin- fixed paraffinembedded tissue blocks

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    Thesis (MMed)--Stellenbosch University, 2019.Background: The ever increasing burden of breast cancer, the most common cancer among women, demands a diagnostic test that is rapid, reliable, informative and cost-effective; particularly in countries with limited financial and medical resources. FNAB cytology and cell block combination has gained worldwide utility and has been described to be accurate and reliable. Aim: Henceforth the aim of this study was to retrospectively correlate the expression of prognostication markers, namely, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) performed on cell blocks (using the BD CytorichTM Red method) and formalin-fixed, paraffin-embedded cell blocks (FFPET) in chemotherapy naive breast carcinomas, by immunochemistry (immunocytochemistry and immunohistochemistry respectively) and to perform fluorescence in-situ hybridization (FISH) testing for over- expression of the HER2 gene. Methods: Between 2013 and 2016, 132 cases of primary breast carcinoma were identified that had both cytology (including Cytorich™ Red cell blocks) and histology specimens that were both chemotherapy naive. Immunostaining for ER, PR and HER2 was performed. The staining was scored according to the Allred scoring system for histology specimen and this system was slightly adapted for cytology specimens, which also took the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines into account. FISH for HER2 over-expression was performed. The grade of the carcinoma was also analysed on both the cytology specimens (using the Robertson’s grading system) and the histology specimens (using the Modified Elston & Ellis system). Results: ER and PR performed on cell blocks had good correlation with FFPET with 91% and 85% sensitivity, respectively. HER2 on cell blocks had an agreement of 88% with FFPET. 87.88% of cell blocks had more than a 100 tumour cells present on H&E sections and cytological grading had an agreement of 41.41% with histological grading. Conclusion: The cell block technique continues to play a vital role in the diagnosis of primary, recurrent and metastatic breast carcinoma, allowing assessment of prognosis and prediction of response to therapy.Agtergrond: Borskanker is die allergrootste las wat op vouens rus en is die mees algemeenste kanker onder vroue. As gevolg hiervan is diagnostiese toetse wat vinnig, bertroubaar en insiggewend is belangrik, veral in lande met beperkte mediese en finansiële hulpbronne. Fyn naald aspirasie en die selblok kombinasie het wêreldwyd nut verwerf en word beskryf as ‘n betroubare en akkurate toets. Doelwitte: Die doelwit van hierdie studie was om retrospektief te korreleer of voorspelling merkers, naamlik estrogeen reseptor (ER), progesteroon reseptor (PR) en menslike epidermale groei faktor reseptor 2 (HER2) uitgevoer op selblokke (met gebruik van die BD Cytorich ™ Red metode) en formalien gefikseerde, paraffien inbedding weefsel blokke in chemoterapie naἲve borskarsinome te korreleer deur immunochemie. Die uitvoering van FISH toetse vir die oor uitdrukking van die HER2 geen was ook gedoen. Metodes: Tussen 2013 en 2016 was 132 gevalle geidentifiseer met ‘n primêre diagnose van borskarsinoom, wat albei sitologie (insluitend BD Cytorich™ Red selblokke) en histologie monsters het. Immunokleuring vir ER, PR en HER2 was gedoen en die kleuring was deur ‘n puntestelsel volgens die Allred stelsel vir histologie gedoen wat egter effens aangepas vir sitologie selblokke was. Die Amerikaanse vereniging van kliniese onkologie (ASCO)/ kollege van amerikaanse patoloë (CAP) riglyne was ook toegepas vir HER2 ontleding asook FISH toetse vir HER2 ekspressie. Die gradering van karsinome was ook geontleed vir beide sitologie monsters met aanwending van die Robinson’s gradering sisteem en vir histolgie monsters met aanwending van die gemodifiseerde Elston en Ellis sisteem. Resultate: ER en PR uitgevoer op selblokke het goeie korrelasie met weefsel blokke getoon met ‘n sensitiwiteit van 91% en ‘n spesifisiteit van 62% vir ER en ‘n sensitiwiteit van 85% en spesifisiteit van 84% vir PR. HER2 op selblokke het ‘n ooreenstemming van 88% gehad met weefsel blokke en 87.88% van die selblokke het meer as 100 tumor selle teenwoordig gehad op H&E snitte. Gradering van sitologie het ‘n ooreenstemming van 41.41% met histologie gradering gehad. Gevolgtrekkinge: Die selblok tegniek speel ‘n belangrike rol in die diagnose van primêre, terugkerende en metastase van borskarsinoom. Terselfte tyd word die berekening van prognose toegelaat asook die voorspelling van toepaslike behandeling

    A correlative study of FNAC, excision biopsy and final diagnosis in benign and malignant breast lumps

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    INTRODUCTION: Fine-needle aspiration cytology (FNAC) was performed on a large scale at Memorial Hospital, New York, during the 1930s, but during the ensuing years, it did not gain much encouragement in United States. The technique had a resurgence in Scandinavia during the 1950s and 1960s, where it flourished before spreading to other parts of the world. For decades, small samples of tissue have been obtained using a needle to diagnose lesions in many anatomical locations. Breast lesions were identified as particularly suitable for the technique due to their accessibility. The use of smears obtained by aspiration for diagnostic purposes was reported as early as 1933, when Stewart’s series of 2,500 specimens included almost 500 breast lesions. The publication of cytology results for a series of 2, 111 fine needle aspiration (FNA) samples by Franzen and Zajicek in 1968 established the technique as a vital part of the assessment of breast lesions. FNA cytology and core biopsy were originally used to diagnose palpable breast lesions. Both methods have a high degree of sensitivity and specificity. FNA cytology is an excellent method for diagnosing palpable lesions; its sensitivity has been reported to be between 89% and 98%5 and its specificity between 98% and 100%. Following the introduction of mammographic screening, FNA cytology is now also used to diagnose impalpable breast lesions. The sensitivity and specificity of stereotactic FNA cytology with impalpable lesions have been reported to be 77–100% and 91–100% respectively. AIMS AND OBJECTIVES: 1. To study the Epidemology of breast disorders in Tirunelveli Medical College Hospital. 2. To assess the value of FNAC in the preoperative evaluation of patients 3. To correlate the findings of FNAC with that of HPE of the excised speciment after surgery. 4. To determine the incidence of malignancy and other Benign lesions of the Breast. 5. The diagnosis of Carcinoma of Breast. 6. The diagnosis of Fibro Cystic Diseases, Which in most cases can be managed medically without the need for surgery. 7. The avoidance of surgery in Doubtful cases where there is no pressing need for operative intervention based on a firm tissue diagnosis. 8. To recognise early breast cancers where there is scope for breast conservation surgery. 9. To analyse the cost-effectiveness of FNAC. METHODS, MATERIALS AND TECHNIQUES: THE TRIPLE TEST: FNA cytology should always be interpreted in the context of the triple test. The triple test is the recommended approach for the investigation of palpable or impalpable breast lesions detected by imaging. It comprises the following components: • Clinical breast examination and medical history • Imaging – mammography and/or ultrasound • Non-excision biopsy – FNA cytology and/or core biopsy. The triple test is positive if any of the three components is positive, and negative if all the components are negative.The triple test has a sensitivity (truepositive rate) of 99.6%, and a specificity of 93%. Irwig and Macaskill (1997) have developed models to illustrate the accuracy of the triple test results for clinically and mammographically detected breast lesions. The aims of the triple test are to: • Maximise the diagnostic accuracy in breast disease. • Maximise the preoperative diagnosis of cancer. • Minimise the proportion of excision biopsies for diagnostic purposes. • Minimise the proportion of benign excision biopsies for diagnostic purposes. OBSERVATION AND RESULTS: “The only function of FNAC is to differentiate neoplastic from non neoplastic tissue” this statement by FERGUSSEN in 1937 may still be valid. 289 patients was enrolled for this study , conducted between July 2003 to February 2006. The age group of patients selected for this study ranged from 15 years to 88 years. Epidemology of Breast Disorders in Tirunelveli Medical College Hospital: The total number of Female Inpatients during the period of this study was 53,723. The percentage of Female Inpatients with Breast disorders (261) in TVMCH during this study period was 0.48 %. The Percentage of female inpatients having Breast cancer (134) during this study period was 0.249 %. Total number of major cases performed in surgery dept during this study period was 19,312.The Percentage of Breast surgeries (289) in TVMCH during this study period was 1.49 %. Out of the 289 patients 28 patients were male. TABLE I and TABLE 11 shows distribution of patients according to their sex and age. The 289 patients selected were clinically examined, investigated, diagnosed and was subsequently operated upon. TABLE 1V shows the distribution of patients according to their preoperative FNAC diagnosis. FNAC was done for all the 289 patients. All the patients enrolled in this study were in-patients and all the patients were followed up, during surgery and after discharge, and their HPE reports were collected by me personally. All the 289 patients readily agreed for the procedure, after proper explanation. Patients showing acellular smear or paucicellular smear were subjected to repeat FNAC. CONCLUSION: The following conclusions were drawn from this study, The Percentage of Female Inpatients with Breast disorders (261) in TVMCH during this study period was 0.48 %. • The Percentage of female inpatients in TVMCH having Breast cancer (134) during this study period was 0.249 %. • Breast surgeries made up 1.49 % of all the major surgeries performed in TVMCH during this study period. 1. The over all accuracy rate of FNAC was 87.92% and it reliably helped to plan the nature of Surgery to be undertaken. With Experience and use of Guidance techniques, the accuracy rate can be Improved to 94-96% at par with current international standards. 2. The sensitivity of this study was 96.26 % for Breast malignancy, and 95.32 % for benign breast disorders. 3. FNAC can reliably diagnose Fibro Cystic disease and Surgery can be avoided for those patients. The 9 patients with FCD operated in this study had a Dominant, Symptomatic and Chronic lump, refractory to medical management. 4. The predictive value of a Positive test for Malignancy was 96.26 % in this study. 5. FNAC was reliable in diagnosing recurrent tumors and Metastatic nodes. 6. Preoperative FNAC report and clinical diagnosis were both correlated before planning a Mastectomy and was Justified in all the patients who underwent Mastectomy. 7. There were no False positive cases this study. 8. FNAC was less accurate in diagnosising & confirming Medullary Carcinoma (50 %), Gynaecomastia (92.3 %) and Phyllodes (90.9 %). With experience and guidance techniques, there results can no doubt be improved upon. 9. FNAC can aid in the follow up of patients, with the least incidence of complication. In this study, there was a only a single case of Haematoma after FNAC in a case of Advanced IDC. 10. There were totally 4 False Negative cases and most of then were due to sampling error, which can be brought down by experience. 11. Females obviously dominated the study with maximum incidence of breast tumors in the 20 to 60 years age group. 12. In 1933, STEWART stated that “diagnosis by aspiration is as reliable as the combined intelligence of the clinician and pathologist ,make it”. This wise euphorism holds good for any study, and will influence the outcome of any study

    Pathological Diagnosis, Work-Up and Reporting of Breast Cancer 1st Central-Eastern European Professional Consensus Statement on Breast Cancer

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    Abstract This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified on the basis of the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The recommendations cover non-operative, intraoperative and postoperative diagnostics, determination of prognostic and predictive markers and the content of cytology and histology reports. Furthermore, they address some specific issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, and some remarks about the future.The 1st Central-Eastern European Professional Consensus Statements on Breast Cancer were initiated, organized and granted by the Central-Eastern European Academy of Oncology (CEEAO), the National Institute of Oncology, Hungary and the Bács-Kiskun County Teaching Hospital. This regional oncological project was supported by Prof. Miklós Kásler, founder of CEEAO, Minister of Human Capacities, the Government of Hungary
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