Outcome of radial scar/complex sclerosing lesion associated with epithelial proliferations with atypia diagnosed on breast core biopsy: results from a multicentric UK-based study.

Aims: The clinical significance of radial scar (RS)/complex sclerosing lesion (CSL) with high-risk lesions (epithelial atypia) diagnosed on needle core biopsy is not well defined. We aimed at assessing the upgrade rate to ductal carcinoma in situ (DCIS) and invasive carcinoma on the surgical excision specimen in a large cohort with RS/CSL associated with atypia.

Methods: 157 women with a needle core biopsy diagnosis of a RS/CSL with atypia and follow-up histology were studied.

Impact of breast cancer grade discordance on prediction of outcome.

Aims: Histological grade is an independent prognostic variable in breast cancer (BC). Previous concordance studies of BC grade have reported moderate levels of agreement; a typical finding in morphological assessment of biological variables. This study aimed to investigate the impact of discordance on the prognostic value of grade and to identify the best reporting approach in borderline cases.

Diagnostic concordance of reporting lymphovascular invasion in breast cancer.

Aims: This study aims to assess the diagnostic agreement of lymphovascular invasion (LVI) in invasive breast cancer (BC).

Methods: Data on LVI were collected from the UK National Health Service Breast Screening Programme pathology external quality assurance scheme database. 101 BCs assessed over a 10-year period (2004-2014) were included.

Efficacy of an incident-reporting system in cellular pathology: a practical experience.

Background And Aims: Incident reporting (IR) refers to systematic documentation of adverse incidents to facilitate their appropriate investigation and institution of corrective or remedial actions, and provide data to identify risk trends for recurrent problems. Minimisation of errors and reduction in process variation is recognised as an important goal of quality management and is an essential part of continuous quality improvement. Published data on the role IR plays in cellular pathology remains scanty.

Screen-detected malignant breast lesions diagnosed following benign (B2) or normal (B1) needle core biopsy diagnoses.

Unlabelled: Breast needle core biopsy (NCB) is now a standard diagnostic procedure in the triple assessment of screen detected breast lesions. However, unlike fine needle aspiration (FNA) cytology, information on the miss rate including false-negative diagnoses (FN) of malignancy (benign 'B2' or normal 'B1' NCB with a malignant outcome) is limited.

Methods: A large series of NCBs (121,742) performed over an 8-year period has been studied to assess the frequency and causes of missing a malignant diagnosis on NCB and to evaluate their impact on patients' management in the screening service.

Triple-negative breast cancer: distinguishing between basal and nonbasal subtypes.

Purpose: Triple-negative (TN; estrogen receptor, progesterone receptor, and HER-2 negative) cancer and basal-like breast cancer (BLBC) are associated with poor outcome and lack the benefit of targeted therapy. It is widely perceived that BLBC and TN tumors are synonymous and BLBC can be defined using a TN definition without the need for the expression of basal markers.

Experimental Design: We have used two well-defined cohorts of breast cancers with a large panel of biomarkers, BRCA1 mutation status, and follow-up data to compare the clinicopathologic and immunohistochemical features of TN tumors expressing one or more of the specific basal markers (CK5/6, CK17, CK14, and epidermal growth factor receptor; BLBC) with those TN tumors that express none of these markers (TN3BKE-).

Screen-detected breast lesions with malignant needle core biopsy diagnoses and no malignancy identified in subsequent surgical excision specimens (potential false-positive diagnosis).

Although breast needle core biopsy (NCB) is now a standard diagnostic procedure in the triple assessment of screen-detected breast lesions, data on the false-positive diagnoses of malignancy (malignant NCB 'B5' with normal/benign surgery) are lacking. In this study, we have studied a large series of NCBs (101,440) to assess the causes and pitfalls resulting in false-positive NCB diagnoses and to evaluate their impact on patients' management in the screening service. Our results showed that of 40,395 malignant NCBs reported during the period of this study, 174 NCBs are considered as false-positives (0.

Audit of performance of needle core biopsy diagnoses of screen detected breast lesions.

Breast needle core biopsy (NCB) is now a standard diagnostic procedure in the triple assessment of screen detected breast lesions. Therefore, it is important to provide robust and up-to-date data on the performance of NCB in the screening setting. However, previous studies of NCB have suffered from either limitation in the number of assessed cases or included a mix of symptomatic and screen detected breast lesions.

Prognostic significance of Nottingham histologic grade in invasive breast carcinoma.

Purpose: The three strongest prognostic determinants in operable breast cancer used in routine clinical practice are lymph node (LN) stage, primary tumor size, and histologic grade. However, grade is not included in the recent revision of the TNM staging system of breast cancer as its value is questioned in certain settings.

Materials And Methods: This study is based on a large and well-characterized consecutive series of operable breast cancer (2,219 cases), treated according to standard protocols in a single institution, with a long-term follow-up (median, 111 months) to assess the prognostic value of routine assessment of histologic grade using Nottingham histologic grading system.

The biological and clinical characteristics of breast carcinoma with mixed ductal and lobular morphology.

Unlabelled: Although invasive ductal (IDC) and lobular (ILC) breast carcinomas are well characterised in the literature, the biological and clinical significance of mixed tumours with both ductal and lobular components has not been investigated. In the current study, we have examined a well-characterised series of breast carcinoma with a long term follow-up that comprised 140 mixed tumours, 2170 IDC and 380 pure ILC.

Results: Mixed tumours constituted 3.

Expression of BRCA1 protein in breast cancer and its prognostic significance.

BRCA1 is a tumor suppressor gene which, when mutated, is associated with the development of hereditary breast cancers. In sporadic tumors, although inherent gene mutations are rare, loss of BRCA1, resulting from reduced expression or incorrect subcellular localization, is postulated to be important. The purpose of the current study was to examine the expression and localization of BRCA1 protein and to assess its prognostic value, in a well-characterized series of unselected breast carcinomas.

Patho-biological aspects of basal-like breast cancer.

Breast cancer comprises a remarkably diverse group of diseases in terms of presentation, morphology, molecular profile and response to therapy. Recent gene expression profiling of breast cancer has identified specific molecular subtypes of clinical significance. Basal-like cancers (BLC) comprise a group of tumours that are characterised by an expression signature similar to that of the basal/myoepithelial cells of the breast and cluster together with BRCA1 associated tumours.

Invasive lobular carcinoma of the breast: response to hormonal therapy and outcomes.

Unlabelled: Invasive lobular carcinoma (ILC) comprises approximately 5-15% of breast cancers and appears to have a distinct biology. It is less common than invasive ductal carcinoma (IDC) and few large studies have addressed its biologic characteristics and behaviour with respect to long-term clinical outcome and response to adjuvant therapy.

Methods: This study is based on a large and well-characterised consecutive series of invasive breast carcinomas with a long-term follow-up (up to 25 years).

Histologic grading is an independent prognostic factor in invasive lobular carcinoma of the breast.

Unlabelled: Invasive lobular carcinoma (ILC) comprises approximately 5-15% of breast cancers and appears to have a distinct biology. As it is less common than invasive ductal carcinoma, few studies of large size have addressed the value of assessment of histologic grade in ILC.

Methods: This study is based on a large and well-characterised consecutive series of breast cancer (4,987 cases), from a single institution, with a long-term follow-up to assess the prognostic value of routine assessment of histologic grade in ILC.

Biologic and clinical characteristics of breast cancer with single hormone receptor positive phenotype.

Purpose: Response to endocrine therapy in breast cancer correlates with estrogen receptor (ER) and progesterone receptor (PgR) status. It is usually easier to decide treatment strategies in cases of double-positive/-negative phenotypes than in single-positive tumors.

Patients And Methods: We have examined a large and well-characterized series of primary invasive breast carcinoma (1,944 cases) with long-term clinical follow-up and hormone therapy data.

Prognostic markers in triple-negative breast cancer.

Background: Triple-negative breast cancer (estrogen receptor-negative, progesterone receptor-negative, and HER2-negative) is a high risk breast cancer that lacks the benefit of specific therapy that targets these proteins.

Methods: In this study, the authors examined a large and well characterized series of invasive breast carcinoma (n = 1944) with a long-term clinical follow-up (median, 56 months) by using tissue microarray. The series were also stained with concurrent immunohistochemical prognostic panels (estrogen receptor, progesterone receptor, HER-2, androgen receptor, epidermal growth factor receptor (EGFR), P-cadherin, E-cadherin, and basal (CK5/6, CK14), and p53), to characterize this specific subgroup of breast cancer and to identify prognostic markers that can identify tumors with more aggressive behavior.