Skip to main content
SpringerLink
Log in

Problematic Core Biopsies

  • Chapter
  • First Online:
Breast Pathology

  • 2009 Accesses

Abstract

This chapter deals with practical problems in the handling and reporting of breast core biopsy specimens, including approaches for identification of histological microcalcifications. The use of reporting categories (“B” codes) is recommended, and the chapter largely concentrates on those entities causing diagnostic difficulties, such as the B3 lesions, of uncertain malignant potential, as well as potentially problematic malignant lesions, albeit these make up a minority of a pathologist’s routine practice.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ciatto S, Houssami N, Ambrogetti D, Bianchi S, Bonardi R, Brancato B, Catarzi S, Risso GG. Accuracy and underestimation of malignancy of breast core needle biopsy: the Florence experience of over 4000 consecutive biopsies. Breast Cancer Res Treat. 2007;101:291–7.

    Article  PubMed  Google Scholar 

  2. Rhodes A, Jasani B, Balaton AJ, Miller KD. Immunohistochemical demonstration of oestrogen and progesterone receptors: correlation of standards achieved on in-house tumors with that achieved on external quality assessment material in over 150 laboratories from 26 countries. J Clin Pathol. 2000;53(4):292–301.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Lee AH, Key HP, Bell JA, Kumah P, Hodi Z, Ellis IO. The effect of delay in fixation on HER2 expression in invasive carcinoma of the breast assessed with immunohistochemistry and in situ hybridisation. J Clin Pathol. 2014;7:573–5.

    Article  Google Scholar 

  4. Kalkman S, Barentsz MW, Witkamp AJ, van der Wall E, Verkooijen HM, van Diest PJ, Kalkman S, Barentsz MW, van Diest PJ. The effects of under 6 hours of formalin fixation on hormone receptor and HER2 expression in invasive breast cancer: a systematic review. Am J Clin Pathol. 2014;142(1):16–22. h.

    Article  PubMed  Google Scholar 

  5. Kalkman S, Barentsz MW, Witkamp AJ, van der Wall E, Verkooijen HM, van Diest PJ. Brief fixation does not affect assessment of hormone receptor expression in invasive breast carcinoma biopsies: paving the road for same-day tissue diagnostics. Am J Surg Pathol. 2014;38(8):1071–8.

    PubMed  Google Scholar 

  6. Moritz JD, Luftner-Nagel S, Westerhof JP, Oestmann JW, Grabbe E. Microcalcifications in breast core biopsy specimens: disappearance at radiography after storage in formaldehyde. Radiology. 1996;200(2):361–3.

    Article  CAS  PubMed  Google Scholar 

  7. Liberman L, Evans 3rd WP, Dershaw DD, Hann LE, Deutch BM, Abramson AF, Rosen PP. Radiography of microcalcifications in stereotaxic mammary core biopsy specimens. Radiology. 1994;190(1):223–5.

    Article  CAS  PubMed  Google Scholar 

  8. Ellis IO, Humphreys S, Michell M, Pinder SE, Wells CA, Zakhour HD. Best Practice No 179. Guidelines for breast needle core biopsy handling and reporting in breast screening assessment. J Clin Pathol. 2007;60(12):1297–9.

    Google Scholar 

  9. Dahlstrom JE, Sutton S, Jain S. Histologic-radiologic correlation of mammographically detected microcalcification in stereotactic core biopsies. Am J Surg Pathol. 1998;22:256–9.

    Article  CAS  PubMed  Google Scholar 

  10. Brennan ME, Turner RM, Ciatto S, Marinovich ML, French JR, Macaskill P, Houssami N. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology. 2011;260:119–28.

    Article  PubMed  Google Scholar 

  11. Bagnall MJ, Evans AJ, Wilson AR, Pinder SE, Denley H, Geraghty JG, Ellis IO. Predicting invasion in mammographically detected microcalcification. Clin Radiol. 2001;56(10):828–32.

    Article  CAS  PubMed  Google Scholar 

  12. Masannat YA, Bains SK, Pinder SE, Purushotham AD. Challenges in the management of pleomorphic lobular carcinoma in situ of the breast. Breast. 2013;22(2):194–6.

    Article  PubMed  Google Scholar 

  13. Jacobs TW, Pliss N, Kouria G, Schnitt SJ. Carcinomas in situ of the breast with indeterminate features: role of E-cadherin staining in categorization. Am J Surg Pathol. 2001;25(2):229–36.

    Article  CAS  PubMed  Google Scholar 

  14. Collins LC, Carlo VP, Hwang H, Barry TS, Gown AM, Schnitt SJ. Intracystic papillary carcinomas of the breast: a reevaluation using a panel of myoepithelial cell markers. Am J Surg Pathol. 2006;30(8):1002–7.

    Article  PubMed  Google Scholar 

  15. Harris GC, Denley HE, Pinder SE, Lee AH, Ellis IO, Elston CW, Evans A. Correlation of histologic prognostic factors in core biopsies and therapeutic excisions of invasive breast carcinoma. Am J Surg Pathol. 2003;27(1):11–5.

    Article  PubMed  Google Scholar 

  16. Naidoo K, Beardsley B, Carder PJ, Deb R, Fish D, Girling A, Hales S, Howe M, Wastall LM, Lane S, Lee AHS, Philippidou M, Quinn C, Stephenson T, Pinder SE. Accuracy of classification of invasive lobular carcinoma on needle core biopsy of the breast. J Clin Pathol 2016. In press. doi:10.1136/jclinpath-2016-203886.

    Google Scholar 

  17. Arnedos M, Nerurkar A, Osin P, A’Hern R, Smith IE, Dowsett M. Discordance between core needle biopsy (CNB) and excisional biopsy (EB) for estrogen receptor (ER), progesterone receptor (PgR) and HER2 status in early breast cancer (EBC). Ann Oncol. 2009;20:1948–52.

    Article  CAS  PubMed  Google Scholar 

  18. Lee AHS. The histological diagnosis of metastases to the breast from extramammary malignancies. J Clin Pathol. 2007;60:1333–41.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tot T. Cytokeratins 20 and 7 as biomarkers: usefulness in discriminating primary from metastatic adenocarcinoma. Eur J Cancer. 2002;38(6):758–63.

    Article  CAS  PubMed  Google Scholar 

  20. Bianchi S, Caini S, Renne G, Cassano E, Ambrogetti D, Cattani MG, Saguatti G, Chiaramondia M, Bellotti E, Bottiglieri R, Ancona A, Piubello Q, Montemezzi S, Ficarra G, Mauri C, Zito FA, Ventrella V, Baccini P, Calabrese M, Palli D, VANCB Study Group. Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): a large multi-institutional study in Italy. Breast. 2011;20(3):264–70.

    Article  CAS  PubMed  Google Scholar 

  21. El-Sayed ME, Rakha EA, Reed J, Lee AH, Evans AJ, Ellis IO. Predictive value of needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening. Histopathology. 2008;53(6):650–7.

    Article  CAS  PubMed  Google Scholar 

  22. Page DL, Rogers LW. Combined histologic and cytologic criteria for the diagnosis of mammary atypical ductal hyperplasia. Hum Pathol. 1992;23(10):1095–7.

    Article  CAS  PubMed  Google Scholar 

  23. Yu YH, Liang C, Yuan XZ. Diagnostic value of vacuum-assisted breast biopsy for breast carcinoma: a meta-analysis and systematic review. Breast Cancer Res Treat. 2010;120(2):469–79.

    Article  PubMed  Google Scholar 

  24. Page DL, Kidd Jr TE, Dupont WD, Simpson JF, Rogers LW. Lobular neoplasia of the breast: higher risk for subsequent invasive cancer predicted by more extensive disease. Hum Pathol. 1991;22(12):1232–9.

    Article  CAS  PubMed  Google Scholar 

  25. Mastracci TL, Shadeo A, Colby SM, Tuck AB, O’Malley FP, Bull SB, Lam WL, Andrulis IL. Genomic alterations in lobular neoplasia: a microarray comparative genomic hybridization signature for early neoplastic proliferation in the breast. Genes Chromosomes Cancer. 2006;45(11):1007–17.

    Article  CAS  PubMed  Google Scholar 

  26. Hussain M, Cunnick GH. Management of lobular carcinoma in situ and atypical lobular hyperplasia of the breast – a review. Eur J Surg Oncol. 2011;37(4):279–89.

    Article  CAS  PubMed  Google Scholar 

  27. Fraser JL, Raza S, Chorny K, Connolly JL, Schnitt SJ. Columnar alteration with prominent apical snouts and secretions: a spectrum of changes frequently present in breast biopsies performed for microcalcifications. Am J Surg Pathol. 1998;22(12):1521–7.

    Article  CAS  PubMed  Google Scholar 

  28. Verschuur-Maes AH, van Deurzen CH, Monninkhof EM, van Diest PJ. Columnar cell lesions on breast needle biopsies: is surgical excision necessary? A systematic review. Ann Surg. 2012;255(2):259–65.

    Article  PubMed  Google Scholar 

  29. O’Malley FP, Bane A. An update on apocrine lesions of the breast. Histopathology. 2008;52(1):3–10.

    Article  PubMed  Google Scholar 

  30. Tse GM, Tan PH, Moriya T. The role of immunohistochemistry in the differential diagnosis of papillary lesions of the breast. J Clin Pathol. 2009;62(5):407–13.

    Article  CAS  PubMed  Google Scholar 

  31. Rakha EA, Lee AH, Jenkins JA, Murphy AE, Hamilton LJ, Ellis IO. Characterization and outcome of breast needle core biopsy diagnoses of lesions of uncertain malignant potential (B3) in abnormalities detected by mammographic screening. Int J Cancer. 2011;129(6):1417–24.

    Article  CAS  PubMed  Google Scholar 

  32. Page DL, Salhany KE, Jensen RA, Dupont WD. Subsequent breast carcinoma risk after biopsy with atypia in a breast papilloma. Cancer. 1996;78:258–66.

    Article  CAS  PubMed  Google Scholar 

  33. Lee AHS, Hodi Z, Ellis IO, Elston CW. Histological features useful in the distinction of phyllodes tumor and fibroadenoma on needle core biopsy of the breast. Histopathology. 2007;51:336–44.

    Article  CAS  PubMed  Google Scholar 

  34. Abdulcadir D, Nori J, Meattini I, Giannotti E, Boeri C, Vanzi E, Vezzosi V, Bianchi S. Phyllodes tumors of the breast diagnosed as B3 category on image-guided 14-gauge core biopsy: analysis of 51 cases from a single institution and review of the literature. Eur J Surg Oncol. 2014;40(7):859–64.

    Article  CAS  PubMed  Google Scholar 

  35. Rakha EA, Shaaban AM, Haider SA, Jenkins J, Menon S, Johnson C, Yamaguchi R, Murphy A, Liston J, Cornford E, Hamilton L, James J, Ellis IO, Lee AHS. Outcome of pure mucocele-like lesions diagnosed on breast core biopsy. Histopathology. 2013;62:894–8.

    Article  PubMed  Google Scholar 

  36. Rakha EA, Ho BC, Naik V, Sen S, Hamilton LJ, Hodi Z, Ellis IO, Lee AH. Outcome of breast lesions diagnosed as lesion of uncertain malignant potential (B3) or suspicious of malignancy (B4) on needle core biopsy, including detailed review of epithelial atypia. Histopathology. 2011;58(4):626–32.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cancer Studies, Guy’s Hospital, King’s College London, 3rd Floor, Bermondsey Wing, Great Maze Pond, London, SE1 9RT, UK

    Sarah E. Pinder

Authors
  1. Sarah E. Pinder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah E. Pinder .

Editor information

Editors and Affiliations

  1. Charing Cross Hospital, Imperial College Healthcare NHS Trust & Imperial College, London, London, United Kingdom

    Sami Shousha

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Pinder, S.E. (2017). Problematic Core Biopsies. In: Shousha, S. (eds) Breast Pathology. Springer, Cham. https://doi.org/10.1007/978-3-319-28655-6_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-28655-6_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-28653-2

  • Online ISBN: 978-3-319-28655-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation