The Value of Hormone Receptor Assessment in Ultrasound Guided Core Needle Biopsy of the Breast

Breast cancer is the most common cancer in women in Western countries after skin tumors. Successful treatment depends on many factors, relies on clinical examination, diagnostic procedures, pathologic evaluation, and good therapy decision. The Pathologic diagnosis should be the determining factor in the decision on therapeutic approach. There are several methods of obtaining tissue samples. The percutaneous ultrasound guided breast Core needle biopsy (CNB) is one of them. The Aim of this Study is to evaluate our experience in the accuracy of hormone receptors assessment in ultrasound guided CNB. In our institution, in last 12 month 60 women (with 67 lesions) underwent Breast CNB. The CNB was performed with 16 Gauge semiautomatic biopsy needle with 15 Gauge coordinated introducer needle. 3-6 specimen (mean 4) were taken during the procedure. We analyzed five factors (histological type, histological grade, estrogen and progesterone receptor status, and HER2 from the biopsied sample. All results were presented at the Multidisciplinary Oncology Team. In addition to demographic data and morphological features of the lesion, we analyzed five pathological factors (histological type, histological grade, estrogen and progesterone receptor status, and HER2 from the biopsied sample. All results were presented at the Multidisciplinary Oncology Team. Ultrasound-guided CNB has proven to be a reliable technique for performing a biopsy for breast. It is a good and reliable, complication free method, for preoperative staging, operative planning as well for prognostic value. It is a cost-effective method, can be performed quickly and in outpatient population, does not deform the breast and multiple lesions can be biopsied. This technique shows a high sensitivity value and offers many advantages over other imaging methods to guide a biopsy. All advantages have made this technique the most widespread used technique to perform a biopsy for a suspicious breast lesion

Među-laboratorijska podudarnost HER-2 pozitivnih karcinoma dojke

Accurate assessment of HER -2 status is essential for identifying patients who will benefit from HER -2 targeted therapy. The aim of the present study was to show results on the concordance between local and central laboratory testing results in HER -2 positive breast cancer patients. In cases with discordant findings, the immunohistochemical (IHC) and/or in situ hybridization (FISH/SISH) analysis was performed in central laboratories. A total of 104 out of 143 (72.72%) breast carcinoma cases were HER -2 positive (score 3+), while nearly 14% of tumors (20/43) showed weak (score 2+) and 12% (19/143) negative IHC staining (score 0 and 1+). After repeated IHC and ISH, 88% (126/143) were classified as HER -2 positive and 12% (17/143) as HER -2 negative cases. The results obtained are in agreement with many studies that confirmed similar discordance in HER -2 testing by IHC and/or FISH between local and central laboratory. Thus, our findings as well as those from other studies support the importance of regular quality assessment of the staining procedures performed and consistency of interpretation of HER -2 test results.Ispravna procjena HER -2 statusa je osnova za pronalaženje bolesnika kojima će koristiti HER -2 ciljana terapija. Cilj istraživanja je bio prikazati rezultate podudarnosti između testiranja HER -2 pozitivnih bolesnika oboljelih od raka dojke pri mjesnom i centralnom laboratoriju. U slučajevima nepodudarnih rezultata analize imunohistokemije (IH) i/ili in situ hibridizacije su se izvodile u centralnim laboratorijima. Ukupno 104 od 143 (72,72%) slučaja karcinoma dojke su bili HER -2 pozitivni (biljeg 3+), dok je skoro 14% tumora (20/43) prikazalo nisko (biljeg 2+) i 12% (19/143) negativno imunohistokemijsko bojenje (biljeg 0 i 1+). Nakon ponovljene analize IH i ISH 88% (126/143) se klasificiralo kao HER -2 pozitivni i 12% (17/143) kao HER -2 negativni slučajevi. Dobiveni rezultati su sukladni mnogim istraživanjima koja potvrđuju slične nepodudarnosti pri HER -2 testiranju imunohistokemijom i/ili FISH analizom između mjesnog i centralnog laboratorija. Prema tome, naši rezultati kao i rezultati drugih istraživanja podupiru značenje pravilnog procjenjivanja izvođenja protokola bojenja i dosljednosti interpretacija rezultata HER -2 testiranja

Interlaboratory concordance in HER-2 positive breast cancer

Accurate assessment of HER-2 status is essential for identifying patients who will benefit from HER-2 targeted therapy. The aim of the present study was to show results on the concordance between local and central laboratory testing results in HER-2 positive breast cancer patients. In cases with discordant findings, the immunohistochemical (IHC) and/or in situ hybridization (FISH/SISH) analysis was performed in central laboratories. A total of 104 out of 143 (72.72%) breast carcinomas cases were HER-2 positive (score 3+), while nearly 14% of tumors (20/43) showed weak (score 2+) and 12% (19/143) negative IHC staining (score 0 and 1+). After repeated IHC and ISH, 88% (126/143) were classified as HER-2 positive and 12% (17/143) as HER-2 negative cases. The results obtained are in agreement with many studies that confirmed similar discordance in HER-2 testing by IHC and/or FISH between local and central laboratory. Thus, our findings as well as of other studies support the importance of regular quality assessment of the staining procedures performed and consistency of interpretation of HER-2 test results

Rare case of multiple perirenal, extra-adrenal myelolipoma: case report, current management options, and literature review

Extra-adrenal myelolipomas are rare, asymptomatic entities, although large tumors may cause local symptoms or hemorrhage. When these lesions occur outside the adrenals in the retroperitoneum, they are radiographically easily confused with both primary and secondary retroperitoneal tumors, which tend to be aggressive. Although myelolipomas are benign and can be managed conservatively, if malignancy is suspected, a surgical procedure is an option. We report a case of a 68-year-old patient with multiple perirenal extra-adrenal myelolipomas. Initial abdominal ultrasound reviled an inhomogeneous mass surrounding the left kidney. Subsequent CT examination of the abdomen showed four separate, extrarenal, well-circumscribed, round-shaped, fat-containing retroperitoneal tumors. Given the significant size of the masses, that compressed major abdominal vessels and the suspicion of liposarcoma, a surgical excision of the lesions was performed. The tumors were easily separated, all surrounding structures were spared, and they were removed completely. Histologically, all masses consisted of hematopoietic and mature fat tissue and the final diagnosis was extra-adrenal myelolipoma. The patient was released from the hospital 7th day after surgery in good condition and at his baseline. Since myelolipomas are, by definition, nonfunctional benign tumors, there was no need for further follow-up. The radiological evaluation and fine needle biopsy are usually sufficient to establish the diagnosis, but in some cases of well-differentiated liposarcoma, the differentiation between myelolipoma and liposarcoma can be challenging. Therefore, considering that myelolipomas and liposarcomas have opposite prognoses, which affects the surgeon\u27s decision on the extent of surgical procedure and further treatment, we also emphasize the importance of intraoperative assessment of the tumor, both by the surgeon and by intraoperative pathology consultation

Rare Case of Multiple Perirenal, Extra-Adrenal Myelolipoma: Case Report, Current Management Options, and Literature Review

Extra-adrenal myelolipomas are rare, asymptomatic entities, although large tumors may cause local symptoms or hemorrhage. When these lesions occur outside the adrenals in the retroperitoneum, they are radiographically easily confused with both primary and secondary retroperitoneal tumors, which tend to be aggressive. Although myelolipomas are benign and can be managed conservatively, if malignancy is suspected, a surgical procedure is an option. We report a case of a 68-year-old patient with multiple perirenal extra-adrenal myelolipomas. Initial abdominal ultrasound reviled an inhomogeneous mass surrounding the left kidney. Subsequent CT examination of the abdomen showed four separate, extrarenal, well-circumscribed, round-shaped, fat-containing retroperitoneal tumors. Given the significant size of the masses, that compressed major abdominal vessels and the suspicion of liposarcoma, a surgical excision of the lesions was performed. The tumors were easily separated, all surrounding structures were spared, and they were removed completely. Histologically, all masses consisted of hematopoietic and mature fat tissue and the final diagnosis was extra-adrenal myelolipoma. The patient was released from the hospital 7th day after surgery in good condition and at his baseline. Since myelolipomas are, by definition, nonfunctional benign tumors, there was no need for further follow-up. The radiological evaluation and fine needle biopsy are usually sufficient to establish the diagnosis, but in some cases of well-differentiated liposarcoma, the differentiation between myelolipoma and liposarcoma can be challenging. Therefore, considering that myelolipomas and liposarcomas have opposite prognoses, which affects the surgeon’s decision on the extent of surgical procedure and further treatment, we also emphasize the importance of intraoperative assessment of the tumor, both by the surgeon and by intraoperative pathology consultation

Interlaboratory concordance in HER-2 positive breast cancer

Accurate assessment of HER -2 status is essential for identifying patients who will benefit from HER -2 targeted therapy. The aim of the present study was to show results on the concordance between local and central laboratory testing results in HER -2 positive breast cancer patients. In cases with discordant findings, the immunohistochemical (IHC) and/or in situ hybridization (FISH/SISH) analysis was performed in central laboratories. A total of 104 out of 143 (72.72%) breast carcinoma cases were HER -2 positive (score 3+), while nearly 14% of tumors (20/43) showed weak (score 2+) and 12% (19/143) negative IHC staining (score 0 and 1+). After repeated IHC and ISH, 88% (126/143) were classified as HER -2 positive and 12% (17/143) as HER -2 negative cases. The results obtained are in agreement with many studies that confirmed similar discordance in HER -2 testing by IHC and/or FISH between local and central laboratory. Thus, our findings as well as those from other studies support the importance of regular quality assessment of the staining procedures performed and consistency of interpretation of HER -2 test results

Među-laboratorijska podudarnost HER-2 pozitivnih karcinoma dojke

Accurate assessment of HER -2 status is essential for identifying patients who will benefit from HER -2 targeted therapy. The aim of the present study was to show results on the concordance between local and central laboratory testing results in HER -2 positive breast cancer patients. In cases with discordant findings, the immunohistochemical (IHC) and/or in situ hybridization (FISH/SISH) analysis was performed in central laboratories. A total of 104 out of 143 (72.72%) breast carcinoma cases were HER -2 positive (score 3+), while nearly 14% of tumors (20/43) showed weak (score 2+) and 12% (19/143) negative IHC staining (score 0 and 1+). After repeated IHC and ISH, 88% (126/143) were classified as HER -2 positive and 12% (17/143) as HER -2 negative cases. The results obtained are in agreement with many studies that confirmed similar discordance in HER -2 testing by IHC and/or FISH between local and central laboratory. Thus, our findings as well as those from other studies support the importance of regular quality assessment of the staining procedures performed and consistency of interpretation of HER -2 test results.Ispravna procjena HER -2 statusa je osnova za pronalaženje bolesnika kojima će koristiti HER -2 ciljana terapija. Cilj istraživanja je bio prikazati rezultate podudarnosti između testiranja HER -2 pozitivnih bolesnika oboljelih od raka dojke pri mjesnom i centralnom laboratoriju. U slučajevima nepodudarnih rezultata analize imunohistokemije (IH) i/ili in situ hibridizacije su se izvodile u centralnim laboratorijima. Ukupno 104 od 143 (72,72%) slučaja karcinoma dojke su bili HER -2 pozitivni (biljeg 3+), dok je skoro 14% tumora (20/43) prikazalo nisko (biljeg 2+) i 12% (19/143) negativno imunohistokemijsko bojenje (biljeg 0 i 1+). Nakon ponovljene analize IH i ISH 88% (126/143) se klasificiralo kao HER -2 pozitivni i 12% (17/143) kao HER -2 negativni slučajevi. Dobiveni rezultati su sukladni mnogim istraživanjima koja potvrđuju slične nepodudarnosti pri HER -2 testiranju imunohistokemijom i/ili FISH analizom između mjesnog i centralnog laboratorija. Prema tome, naši rezultati kao i rezultati drugih istraživanja podupiru značenje pravilnog procjenjivanja izvođenja protokola bojenja i dosljednosti interpretacija rezultata HER -2 testiranja