Skip to main content

Advertisement

SpringerLink
Log in

Surgeon-Performed Touch Preparation of Breast Core Needle Biopsies May Provide Accurate Same-Day Diagnosis and Expedite Treatment Planning

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We aimed to determine the accuracy of surgeon-performed touch-preparation cytology (TPC) of breast core-needle biopsies (CNB) and the ability to use TPC results to initiate treatment planning at the same patient visit.

Methods

A single-institution retrospective review of TPC results of ultrasound-guided breast CNB was performed. All TPC slides were prepared by surgeons performing the biopsy and interpreted by the pathologist. TPC results were reported as positive/suspicious, atypical, negative/benign, or deferred; these were compared with final pathology of cores to calculate accuracy. Treatment planning was noted as having taken place if the patient had requisition of advanced imaging, referrals, or surgical planning undertaken during the same visit.

Results

Four hundred forty-seven CNB specimens with corresponding TPC were evaluated from 434 patient visits, and 203 samples (45.4 %) were malignant on final pathology. When the deferred, atypical, and benign results were considered negative and positive/suspicious results were considered positive, sensitivity and specificity were 83.7 % (77.9–88.5 %) and 98.4 % (95.9–99.6 %), respectively; positive and negative predictive values were 97.7 % (94.2–99.4 %) and 87.9 % (83.4–91.5 %), respectively. In practice, patients with atypical or deferred results were asked to await final pathology. An accurate same-day diagnosis (TPC positive/suspicious) was hence feasible in 83.7 % (170 of 203) of malignant and 79.5 % (194 of 244) of benign cases (TPC negative). Of patients who had a same-day diagnosis of a new malignancy, 77.3 % had treatment planning initiated at the same visit.

Conclusions

Surgeon-performed TPC of breast CNB is an accurate method of same-day diagnosis that allows treatment planning to be initiated at the same visit and may serve to expedite patient care.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Devaraj S, Iqbal M, Donnelly J, Corder, AP. Axillary ultrasound in invasive breast cancer: experience of our surgeons. Breast J. 2011;17:191–195.

    Article  PubMed  Google Scholar 

  2. Law MT, Bennett IC. Structured ultrasonography workshop for breast surgeons: is it an effective training tool? World J Surg. 2010;34:549–554.

    Article  PubMed  Google Scholar 

  3. Layeequr Rahman R, Crawford S, Hall T, et al. Surgical-office-based versus radiology-referral-based breast ultrasonography: a comparison of efficiency, cost, and patient satisfaction. J Am Coll Surg. 2008;207:763–766.

    Article  PubMed  Google Scholar 

  4. Holmes DR, Silverstein MJ. A minimally invasive breast biopsy clinic: an innovative way to teach breast fellows how to perform breast ultrasound and ultrasound-guided breast procedures. Am J Surg. 2006;192:439–443.

    Article  PubMed  Google Scholar 

  5. Rakha EA, Ellis IO. An overview of assessment of prognostic and predictive factors in breast cancer needle core biopsy specimens. J Clin Pathol. 2007;60:1300–1306.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Willems SM, van Deurzen CH, van Diest PJ. Diagnosis of breast lesions: fine-needle aspiration cytology or core needle biopsy? A review. J Clin Pathol. 2012;65:287–292.

    Article  CAS  Google Scholar 

  7. Garg S, Mohan H, Bal A, Attri AK, & Kochhar S, et al. A comparative analysis of core needle biopsy and fine-needle aspiration cytology in the evaluation of palpable and mammographically detected suspicious breast lesions. Diagn Cytopathol. 2007; 35:681–689.

    Article  PubMed  Google Scholar 

  8. Smith MJ, Heffron CC, Rothwell JR, Loftus BM, Jeffers M, & Geraghty JG, et al. Fine needle aspiration cytology in symptomatic breast lesions: still an important diagnostic modality? Breast J. 2012;18:103–110.

    Article  PubMed  Google Scholar 

  9. Maeda S, Hosone M, Katayama H, Isobe H, Yanagida Y, Egami K, et al. Rapid diagnosis at the outpatient clinic for breast tumors by fine needle aspiration cytology: the utility. Nihon Ika Daigaku Zasshi. 1998;65:416–420.

    CAS  PubMed  Google Scholar 

  10. Dayal S, Murray J, Wilson K, Lannigan A, et al. Imprint cytology from core biopsies increases the sensitivity of fine needle aspiration (FNA) in breast cancer patients. Magy Seb. 2011;64:59–62.

    Article  PubMed  Google Scholar 

  11. Kass R, Henry-Tillman RS, Nurko J, Korourian S, Mancino AT, Colvert M, et al. Touch preparation of breast core needle specimens is a new method for same-day diagnosis. Am J Surg. 2003;186:737–741.

    Article  PubMed  Google Scholar 

  12. Galen RS, Gambino SR. Beyond normality: the predictive value and efficiency of medical diagnoses. New York: Wiley; 1975.

    Google Scholar 

  13. Dey P, Bundred N, Gibbs A, Hopwood P, Baildam A, Boggis C, et al. Costs and benefits of a one stop clinic compared with a dedicated breast clinic: randomised controlled trial. BMJ. 2002;324:507.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Kulkarni D, Irvine T, Reyes RJ. The use of core biopsy imprint cytology in the ‘one-stop’ breast clinic. Eur J Surg Oncol. 2009;35:1037–1040.

    Article  CAS  PubMed  Google Scholar 

  15. Carmichael AR, Berresford A, Sami A, Boparai R. Imprint cytology of needle core-biopsy specimens of breast lesion: is it best of both worlds? Breast. 2004;13:232–234.

    Article  CAS  PubMed  Google Scholar 

  16. Klevesath MB, Godwin RJ, Bannon R, Munthali L, & Coveney E. Touch imprint cytology of core needle biopsy specimens: a useful method for immediate reporting of symptomatic breast lesions. Eur J Surg Oncol. 2005;31:490–494.

    Article  CAS  PubMed  Google Scholar 

  17. Masood S, Feng D, Tutuncuoglu O, Fischer G, Bakhshandeh M, Bertholf RL, et al. Diagnostic value of imprint cytology during image-guided core biopsy in improving breast health care. Ann Clin Lab Sci. 2011;41:8–13.

    PubMed  Google Scholar 

  18. Qureshi NA, Beresford A, Sami S, Boparai R, Gosh S, & Carmichael AR, et al. Imprint cytology of needle core-biopsy specimens of breast lesions: is it a useful adjunct to rapid assessment breast clinics? Breast. 2007;16:81–85.

    Article  CAS  PubMed  Google Scholar 

  19. Farshid G, Pieterse S. Core imprint cytology of screen-detected breast lesions is predictive of the histologic results. Cancer. 2006;108:150–156.

    Article  PubMed  Google Scholar 

  20. Jones L, Lott MF, Calder CJ, & Kutt E. Imprint cytology from ultrasound-guided core biopsies: accurate and immediate diagnosis in a one-stop breast clinic. Clin Radiol. 2004;59:903–908.

    Article  CAS  PubMed  Google Scholar 

  21. Dixon JM, Mansel RE. ABC of breast diseases: symptoms assessment and guidelines for referral. BMJ. 1994;309:722–726.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Eastman A, Tammaro Y, Moldrem A, Andrews V, Huth J, Euhus D, et al. Outcomes of delays in time to treatment in triple negative breast cancer. Ann Surg Oncol. 2013; 20: 1880–1885.

    Article  PubMed  Google Scholar 

  23. Mujar M, Dahlui M, Yip CH, & Taib NA, et al. Delays in time to primary treatment after a diagnosis of breast cancer: does it impact survival? Prev Med. 2013; 56: 222–224.

    Article  PubMed  Google Scholar 

  24. Brazda A, Estroff J, Euhus D, Huth J, Andrews V, Moldrem A, et al. Delays in time to treatment and survival impact in breast cancer. Ann Surg Oncol. 2010; 17(Suppl. 3): 291–296.

    Article  PubMed  Google Scholar 

  25. Sainsbury JR, Johnston C, Haward B. Effect on survival of delays in referral of patients with breast-cancer symptoms: a retrospective analysis. Lancet. 1999;353:1132–1135.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

This research was supported by a Grant from the Arkansas Breast Cancer Research Program and the University of Arkansas for Medical Sciences Translational Research Institute (CTSA Grant Award 1UL1RR029884).

Disclosure

The authors report no disclosures or conflict of interest.

Author information

Authors and Affiliations

  1. Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, USA

    Pranjali V. Gadgil MBBS, Daniela Ochoa MD, Riley Lipschitz BS, Ronda Henry-Tillman MD & V. Suzanne Klimberg MD

  2. Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Soheila Korourian MD & V. Suzanne Klimberg MD

  3. Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Sharp Malak MD, MPH

  4. Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Sharp Malak MD, MPH

Authors
  1. Pranjali V. Gadgil MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Soheila Korourian MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sharp Malak MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniela Ochoa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Riley Lipschitz BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ronda Henry-Tillman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. V. Suzanne Klimberg MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Suzanne Klimberg MD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10434_2013_3440_MOESM1_ESM.jpg

Supplementary fig. a Invasive lobular carcinoma. a Touch preparation cytology (TPC) showing an admixture of benign and malignant cells. The benign clusters appear as tight three-dimensional clusters. The malignant clusters are composed of discohesive epithelial cells (hematoxylin and eosin; original magnification, 10×). b TPC showing isolated neoplastic cells with eccentric nuclei (hematoxylin and eosin; original magnification, 40×). c Corresponding core biopsy showing an invasive lobular carcinoma (hematoxylin and eosin; original magnification, 10×). d Corresponding immunostain for E-cadherin confirming the diagnosis. The arrow shows a benign ductal structure as an internal control (JPEG 104 kb)

10434_2013_3440_MOESM2_ESM.jpg

Supplementary fig. b Mucinous carcinoma. a Touch preparation cytology showing cluster of isolated hyperchromatic (blue arrow) areas in a background of mucin (black arrows) and blood (hematoxylin and eosin; original magnification, 10×). b Higher magnification showing isolated epithelial cells with eccentric and hyperchromatic nuclei (original magnification, 40×). c Corresponding core biopsy showing an multiple clusters of neoplastic epithelial cells within a pool of mucin (hematoxylin and eosin; original magnification, 20×) (JPEG 114 kb)

10434_2013_3440_MOESM3_ESM.jpg

Supplementary fig. c Papilloma. a Touch preparation cytology showing a hypercellular smear with cohesive two-dimensional clusters admixed with single files of cells indicated by blue arrows (hematoxylin and eosin; original magnification, 10×). b Higher magnification of this cluster shows a single file of epithelial cells with eccentric nuclei. These cells are worrisome for malignancy. c Corresponding core biopsy showing a papilloma with extensive adenosis (hematoxylin and eosin; original magnification, 10×). d Papilloma with adenosis (original magnification, 20×) (JPEG 83 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gadgil, P.V., Korourian, S., Malak, S. et al. Surgeon-Performed Touch Preparation of Breast Core Needle Biopsies May Provide Accurate Same-Day Diagnosis and Expedite Treatment Planning. Ann Surg Oncol 21, 1215–1221 (2014). https://doi.org/10.1245/s10434-013-3440-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-013-3440-5

Keywords

Search

Navigation