PubMed · 16306533
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
Kim R Geisinger, William G Ward, Edward A Levine. 2005-11-24. Soft-tissue sarcoma.. https://doi.org/10.1056/nejm200511243532121
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
BACKGROUND: A review of the literature indicated variable underestimation rates for breast core-needle biopsy (CNB) based on generally small series. In this article, the authors present precise estimates for overall underestimation and for categories of histologic underestimates (including categories that reflect contemporary classification) and examine the effect of lesion and sampling variables. METHODS: Among 4035 consecutive CNBs, the authors examined women whose CNB outcome represented a potential underestimate of malignancy (benign but of uncertain biologic or malignant potential or B3 and ductal carcinoma in situ [DCIS]). From 889 eligible women, all 758 women who had excision histology available were included. RESULTS: Overall underestimation of CNB was 27.7% (95% confidence interval [95% CI], 24.5-30.9%). The following category-specific rates were used: B3 underestimates, 36.2% (95% CI, 30.6-41.8%); B3 underestimates (excluding atypical proliferations), 17.9% (95% CI, 10.8-24.9%); atypical ductal hyperplasia underestimates, 29.0% (95% CI, 21.4-36.6%; upgraded to DCIS) and 44.2% (95% CI, 36.0-52.5%; upgraded to DCIS or invasive cancer); and DCIS underestimates, 22.8% (95% CI, 19.0-26.5%). There was a significant trend toward greater underestimation of malignancy with increasing lesion size on imaging studies for overall underestimates (P = .00008), B3 underestimates (P = .009), and DCIS underestimates (P = .0007). Underestimation rates did not differ between masses (27.9%) and microcalcifications (27.6%; chi-square statistic with 1 degree of freedom = 3.02; P = .98) and were significantly lower for vacuum-assisted CNB (11-gauge) than for automated CNB (14-gauge; P = .001). Underestimation rates, when sampling microcalcifications, decreased with increasing number of cores collected, but this was mainly for DCIS underestimates. CONCLUSIONS: CNB results that were not definitely negative or were not positive for invasive cancer were associated with high rates of underestimation of disease and with target lesion size. Identifying imaging or sampling factors that affect underestimation rates of CNB may assist in reducing their occurrence and better predicting excision histology outcomes.
Pancreatic tuberculosis is an extremely rare form of extrapulmonary disease. The diagnosis preoperatively is difficult because clinical, laboratory and radiologic findings are nonspecific. Published data indicate that these lesions mimic cystic neoplasms of the pancreas and the confirmation of clinical suspicion could only be obtained by an open surgical biopsy. Recently, fine needle aspiration cytology has been shown to be a safe, reliable and cost-effective alternative. We report a new case of a peripancreatic tuberculosis in a 52 year old woman and review the relevant literature, paying special attention to the usefulness of endoscopic ultrasound guided-fine needle aspiration in the diagnosis of abdominal tuberculosis.
CONTEXT: Phyllodes tumors are rare fibro-epithelial lesions which make up less than 1% of all breast neoplasms. After curative surgery, distant metastases may occur without local recurrence; the typical sites of the metastases being the lungs and the bones. Endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration (EUS-FNA) has emerged as the leading modalities for the evaluation of pancreatic masses. Until now, there have been no published reports on the use of EUS-FNA to diagnose recurrent phyllodes tumors metastatic to the pancreas. CASE REPORT: A 55-year-old female was hospitalized for the problem of painless obstructive jaundice due to a pancreatic head mass causing biliary obstruction. She had a past history of a left breast phyllodes tumor treated with mastectomy. The diagnostic dilemma was whether this was a case of primary pancreatic cancer or a recurrent phyllodes tumor presenting as a pancreatic metastasis. EUS-FNA of the mass was performed and it revealed a metastatic phyllodes tumor. The patient was treated with palliative biliary stenting and was referred for palliative chemotherapy. CONCLUSION: This is the first report of a recurrent phyllodes tumor metastatic to the pancreas diagnosed using EUS-FNA. It highlights the utility of EUS-FNA in characterizing the nature of pancreatic head masses.