Can galactography-guided stereotactic, 11-gauge, vacuum-assisted breast biopsy of intraductal lesions serve as an alternative to surgical biopsy?

The purpose of this study was to determine the value of galactography-guided, stereotactic, vacuum-assisted breast biopsy (VABB) for the assessment of intraductal breast lesions and its potential as a therapeutic tool that could eliminate the need for surgical excision. Eighteen patients (median age 64 years, range 37-80) with nipple discharge and galactography-verified intraductal lesions underwent galactography-guided, stereotactic, 11-gauge VABB followed by surgery. Histopathology findings from VABB and subsequent surgery were compared. Underestimation and false-negative rates were assessed. After VABB, histopathology revealed invasive ductal carcinoma (IDC) in three (17%), ductal carcinoma in situ (DCIS) in six (33%), high-risk lesions in six (33%) and benign lesions in three (17%) cases. After surgical biopsy, histopathology confirmed the previously established diagnosis in 11 lesions (61%). The underestimation rate for high-risk lesions and DCIS was 50% (6/12). The false-negative rate was 7% (1/14). Histopathology examination after surgery showed that not a single lesion had been completely removed at VABB. Galactography-guided VABB is a feasible diagnostic tool. However, its value as a therapeutic procedure is limited because of the high number of underestimated and missed lesions and because of the histopathological detection of lesions' remnants in every case. Surgical excision should be the therapeutic gold standard in cases of pathological nipple discharge and galactography abnormalities

Quantitative apparent diffusion coefficient measurements obtained by 3-Tesla MRI are correlated with biomarkers of bladder cancer proliferative activity.

PURPOSE:To investigate the association between Apparent Diffusion Coefficient (ADC) values and cell cycle and proliferative biomarkers (p53, p21, Ki67,) in order to establish its potential role as a noninvasive biomarker for prediction of cell cycle, proliferative activity and biological aggressiveness in bladder cancer. MATERIALS AND METHODS:Patients with bladder cancer who underwent 3,0 Tesla DW-MRI of the bladder before TUR-B or radical cystectomy were eligible for this prospective IRB-approved study. Histological specimen were immunohistochemically stained for the following markers: p53, p21 and ki67. Two board-certified uropathologists reviewed the specimens blinded to DW-MRI results. Histological grade and T-stage were classified according to the WHO 2004 and the 2009 TNM classification, respectively. Nonparametric univariate and multivariate statistics including correlation, logistic regression and ROC analysis were applied. RESULTS:Muscle invasive bladder cancer was histologically confirmed in 10 out of 41 patients. All examined tissue biomarkers were significantly correlated with ADC values (p<0.05, respectively). Based on multivariate analysis, p53 and ADC are both independent prognostic factors for muscle invasiveness of bladder cancer (>/ = T2). (p = 0.013 and p = 0.018). CONCLUSION:ADC values are associated with cell cycle and proliferative biomarkers and do thereby reflect invasive and proliferative potential in bladder cancer. ADC and p53 are both independent prognostic factors for muscle invasiveness in bladder cancer

47 year old male patient. MRI images (right: T2w, middle: DWI, left: ADC map) show an intravesical mass.

<p>ADC value was measured as 1.081 *10⁻³ mm²/s. Lower row shows immunohistochemical stainings. Percentage of positive cells was 6% (P53), 12% (Ki67) and 71% (P21). Histopathology showed non-muscle invasive low-grade bladder cancer stage Ta.</p

Spearman's correlation coefficient matrix with color-coded correlation coefficients (upper right denotes correlation coefficients as bubble size while lower left provides the actual coefficients as numbers).

<p>Blank spaces indicate a nonsignificant correlation defined by a P-value of >0.01.</p

71 year old male patient. MRI images (upper row, right: T2w, middle: DWI, left: ADC map) show an intravesical mass.

<p>ADC value was measured as 0.655 *10⁻³ mm²/s. Lower row shows immunohistochemical stainings. Percentage of positive cells was 92% (P53), 69% (Ki67) and 1% (P21). Histopathology showed muscle invasive high-grade bladder cancer stage T2a.</p

Mean ADC values stratified by molecular biomarker results.

<p>*derived from two-sided Mann-Whitney-U test.</p><p>Mean ADC values stratified by molecular biomarker results.</p

Clinicopathological features stratified by biomarker results.

<p>Clinicopathological features stratified by biomarker results.</p

Multivariate binary logistic regression models and their according area under the ROC curve (AUC) for prediction of clinicopathological bladder cancer features.

<p>Method: forward feature selection (likelihood ratios).</p><p>Nagelkerke R-squared: *0.574, ^°:0.445, ⁺: 0.852, ^|: 0.244.</p><p>Hosmer and Lemeshow test: *P = 0.229, ^°P = 0.901, ⁺P = 0.225, ^|P = 0.244.</p><p>Multivariate binary logistic regression models and their according area under the ROC curve (AUC) for prediction of clinicopathological bladder cancer features.</p