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Shahla Masood

Publications and source records attributed to Shahla Masood.

15 recordsLinked to original sources
PubMed2003

Is core needle biopsy superior to fine-needle aspiration biopsy in the diagnosis of papillary breast lesions?

Since the 1980s core needle biopsy (CNB) has gained remarkable popularity and in many institutions it has replaced fine-needle aspiration biopsy (FNAB). However, similar to FNAB, limitation remains in the ability of this procedure to reliably diagnose a small, but prognostically significant, number of breast lesions. These include entities such as atypical ductal hyperplasia, fibro-epithelial tumors, radial scar, papillary lesions, and lobular neoplasia. To assess the diagnostic accuracy of CNB vs. FNAB in the same breast lesions, we reviewed our cases of papillary lesions of the breast. In a retrospective study, we identified 36 cases of FNAB and 11 cases of CNB diagnosed as papillary lesions and compared the results with their corresponding surgical specimen. Interpretation ranged from papillary vs. atypical papillary lesions favoring benign vs. malignant tumors, respectively. Occasionally, definitive diagnosis of papillary carcinoma was entertained. Immunohistochemical staining with smooth muscle actin was used to evaluate the presence or absence of a myoepithelial cell layer. FNAB had benign findings in 21 lesions, atypical in 10, and malignant in five. Of the five lesions yielding malignant features, four had invasive carcinoma and one had micropapillary ductal carcinoma in situ (DCIS). Surgery revealed invasive carcinoma in three of the cases interpreted as atypical papillary lesions and invasive cancer and micropapillary DCIS in three of the cases diagnosed as benign lesions. Similar results were obtained with CNB. DCIS was found in one out of six of the cases diagnosed as papilloma. Out of the four cases that were interpreted as atypical papillary lesion, surgery revealed invasive carcinoma in one case and one case had micropapillary DCIS. Diagnosis of malignancy was confirmed by histology in one case interpreted as papillary carcinoma by CNB. This study suggested that both FNAB and CNB share similar diagnostic challenges and a follow-up surgical excision is indicated when diagnosis of a papillary lesion is entertained by both procedures.

Biopsy, Needle↗
PubMed2002

A subset of breast invasive ductal carcinoma with distinctive cytomorphology, aggressive clinical behavior, and unique immunologic profiles.

BACKGROUND: Invasive ductal carcinoma of the breast is a heterogeneous collection of divergent types of carcinomas. Some subtypes have been characterized by histologic observations. This study describes a distinctive subset recognized through cytomorphologic examination of breast carcinoma specimens obtained by fine-needle aspiration biopsies (FNAB). Identification of this subset is established further by analyses of its clinical and immunologic characteristics. METHODS: One hundred patients underwent FNAB and were diagnosed with breast ductal carcinoma. These diagnoses were followed by surgical resections and histologic evaluation of tumors. Immunohistochemical analyses of estrogen receptor, progesterone receptor, Her2/neu, p53 protein, and Ki-67 were performed. Patient's age, race, and family history of breast carcinoma were obtained. The objective of the study is to identify a cytomorphologically distinctive, clinically relevant, subset of breast carcinomas. RESULTS: A subset carcinoma was recognized by cytomorphologic examination of Pap-stained FNAB slides. This subset consisted of seven patients with a median age of 37 years. At the time of surgical resection, all patients had axillary lymph node metastases. Six of seven patients had distant metastases. Immunohistochemical studies revealed that all tumors are positive for p53 protein and negative for estrogen and progesterone receptors. CONCLUSION: This study presented a unique subset of breast ductal carcinomas that involved young patients and had aggressive growth behavior. These tumors expressed p53 protein but not estrogen and progesterone receptors.

Adult↗
PubMed2002

Prognostic and predictive value of HER2/neu oncogene in breast cancer.

Assessment of HER2/neu oncogene has been used as both a prognostic and predictive marker for breast cancer. However, the choice of the best method to assess the status of HER2/neu oncogene in breast cancer tissue remains controversial. A variety of techniques are available to detect HER2/neu gene amplification and overexpression. Tissue-based detection methods by immunohistochemistry (IHC) and/or fluorescence in situ hybridization (FISH) offers a clear advantage over other approaches. FISH is a costly and relatively difficult assay and yet appears to be a better predictor of response to Herceptin (Trastuzumab) therapy and patient outcome. IHC is less expensive and is easier to perform; however, it suffers from a high rate of false negativity and positivity as well as inter-observer variability among pathologists. Suggestions have been made to use IHC as a screening procedure followed by confirmation by FISH in selected cases. Considering the importance of an accurate assessment of HER2/neu oncogene in selecting therapy, a better alternative may be to use FISH as the primary testing for HER2/neu oncogene. Herceptin therapy is associated with several side effects and is expensive. Thus, in the long term, it may be more cost-effective to use the FISH procedure and reduce the possibility of under-treatment or over-treatment of breast cancer patients. In addition, assessment of HER2/neu oncogene on every newly diagnosed early breast carcinoma may not be necessary. Metastatic lesions, when they occur, can be sampled by fine needle aspiration biopsy or core needle biopsy for assessment of HER2/Neu status.

Antibodies, Monoclonal↗
PubMed2002

A phase II breast cancer chemoprevention trial of oral alpha-difluoromethylornithine: breast tissue, imaging, and serum and urine biomarkers.

PURPOSE: A double-blind randomized Phase II chemoprevention trial of alpha-difluoromethylornithine (DFMO) was conducted in a group of women at high risk for development of breast cancer. DFMO is an irreversible inhibitor of ornithine decarboxylase, the limiting enzyme of polyamine synthesis that is often up-regulated in breast cancer. EXPERIMENTAL DESIGN: Study entrants were required to have random periareolar fine-needle aspiration cytology prior to entry that exhibited hyperplasia or hyperplasia with atypia, as well as a mammogram and clinical breast exam judged as not suspicious for breast cancer and no clinical hearing loss. Subjects were randomized to 6 months of oral DFMO (0.5 g/m(2)/day) or placebo, followed by repeat fine-needle aspiration and biomarker assessment. The main study end point was an improvement in cytologic pattern. RESULTS: Of 119 subjects entered, 96% completed the study and were evaluable for the main study end point. A modest reduction (28%) in average total urine polyamines was obtained in the DFMO group, but there was no reduction in the spermidine:spermine ratio. There was no difference in cytologic improvement between DFMO and placebo. Likewise, there was no difference between DFMO and placebo for the secondary end points of breast molecular marker changes (immunocytochemical expression of proliferating cell nuclear antigen, p53, and epidermal growth factor receptor), mammographic breast density, serum insulin-like growth factor I: insulin-like growth factor binding protein 3 ratio, adverse events, quality of life indices, or subsequent cancer development. CONCLUSIONS: DFMO at a dose level of 0.5 g/m(2)/day administered for 6 months does not modulate breast risk biomarkers tested in this study.

Administration, Oral↗
PubMed2000

Response.

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Journal Article↗
PubMedDate not supplied

The expanding role of pathologists in the diagnosis and management of breast cancer: Worldwide Excellence in Breast Pathology Program.

Pathology is the study of human illness and it involves the morphologic and biologic recognition of abnormalities that are associated with a disease. Breast pathology represents an excellent example of this discipline. By providing diagnostic information and by characterizing the biologic behavior of a breast lesion, a pathologist plays a critical role in a patient's life. Any mistake in this exercise is associated with serious consequences. In addition, there are many unresolved issues in breast pathology, which contribute to our limited understanding of the biology of breast cancer, variability in diagnostic criteria, and significant diversity in breast cancer management and therapy. Furthermore, breast pathology has remained an underrecognized discipline, and its importance in diagnosis and disease management is not fully realized. In order to better serve our patients, particularly medically underserved women and those living in countries with limited resources, we must place emphasis on effectively using the talent and expertise of pathologists around the globe. For example, to provide a cost-effective way to diagnose breast cancer, particularly at advanced stages, pathologists can sample lesions by fine-needle aspiration biopsy (FNAB), stain the resulting smears, and provide an immediate bedside diagnosis. This is a valid contribution; however, this exercise requires the availability of a pathologist with experience in breast cytopathology. Alternatively the pathologist may seek consultations from more experienced pathologists. Developing strategies to better recognize the importance of high-quality breast pathology services and to train qualified and innovative breast pathologists is an ambitious task. The proposed Worldwide Excellence in Breast Pathology Program may provide such an opportunity.

Breast↗
PubMedDate not supplied

Diagnosis of breast cancer in countries with limited resources.

Accurate diagnosis is a necessary step in the management of breast cancer. In women with breast cancer, diagnosis can confirm the presence of the disease, reduce treatment delays, and clarify the predictive and prognostic features of the cancer, which help in planning treatment and counseling women. In women with benign breast conditions, accurate diagnosis avoids erroneous treatment for breast cancer, which can have devastating consequences for the woman and unnecessarily consumes resources. The panel distinguishes between a "clinical diagnosis" of breast cancer (one based on signs and symptoms and imaging findings) and a "pathologic diagnosis" of breast cancer (one based on microscopic examination of cellular or tissue samples). The panel agrees that all women should have a pathologic diagnosis of breast cancer before they are given definitive treatment for the disease, no matter how strongly their clinical findings suggest cancer. The tools for clinical diagnosis include history, clinical breast examination, ultrasound, and diagnostic mammography; these tools provide valuable information and play important supplemental roles in ascertaining the presence of breast cancer. Mammography and ultrasound also help determine the extent of disease within the breast, which is essential when breast-conserving therapy can be offered to women. The tools for pathologic diagnosis include fine-needle aspiration biopsy, core needle biopsy, and standard surgical biopsy. The panel noted that each of these tools has potential benefits and limitations in the limited-resource setting, and concluded that the choice among them must be based on the available tools and expertise. The triple test-checking for correlation of pathology findings, imaging findings, and clinical findings-was identified as a critical practice in diagnosing breast cancer. Panelists uniformly agreed that mastectomy should not be used to diagnose breast cancer, noting that accurate diagnosis can be made by less invasive means. Expertise in pathology was identified as a key requirement for ensuring reliable diagnostic findings. Several approaches were proposed for improving breast pathology, including training pathologists, establishing pathology services in centralized facilities, and organizing international pathology services.

Biopsy, Needle↗
PubMedDate not supplied

Implementation of a minimally invasive breast biopsy program in countries with limited resources.

Minimally invasive breast biopsy techniques, such as core needle biopsy (CNB) and fine-needle aspiration biopsy (FNAB), offer several advantages over surgical biopsy. Patients in whom minimally invasive biopsy techniques are used may undergo biopsy more quickly, are more likely to have only one surgery for treatment of the breast tumor and axillary staging, and are less likely to need reoperation after breast-conserving surgery because of positive margins. Knowledge of a diagnosis of cancer before surgery allows patients to participate in treatment decisions, and compared with surgical biopsy, minimally invasive biopsy has lower costs, produces less scarring, has nearly equivalent diagnostic accuracy, and does not require general anesthesia or sedation. Minimally invasive biopsy can permit accurate diagnosis and prompt intervention in a cost-effective manner, particularly in countries with limited resources, where patients often present with advanced-stage breast cancer. Several events characterize the implementation of a successful program in minimally invasive breast biopsy: public education about the less invasive nature of these techniques, which may encourage women to seek care at earlier stages; a change in the philosophy of medical personnel that favors involving patients in treatment decisions and acceptance of less extensive but accurate methods of diagnosis; education of medical personnel in the selection of patients for minimally invasive biopsy, performance of the biopsy, and interpretation of histologic and/or cytologic samples; quality assessment and use of the triple test (i.e., correlation of clinical, radiologic, and pathologic findings); and economical use of resources, which results from the lower costs of minimally invasive procedures and the avoidance of unnecessary surgery for benign conditions.

Biopsy, Needle↗