Loss of high-molecular-weight cytokeratin antigenicity in prostate tissue obtained by transurethral resections

OBJECTIVE: Staining of prostatic basal cells for the expression of high-molecular-weight cytokeratin has been suggested as a way of distinguishing benign from malignant prostate glands. We evaluated the utility of high-molecular-weight cytokeratin in the diagnosis of malignancy in prostate specimens obtained in various ways. DESIGN: Prostate tissues obtained from needle biopsies, transurethral resections, and total prostatectomies were immunostained with monoclonal antibody 34betaE12, an antibody directed against high-molecular-weight cytokeratins. RESULTS: Antiserum to high-molecular-weight cytokeratin only stained the basal cells in normal glands in 3 (12%) of 25 specimens obtained by transurethral resection. Other antigens, such as the alternate 10-nm filament protein vimentin, were unaffected and were detected in 100% of these specimens. However, keratin antigenicity in transurethral biopsies could be restored in these specimens by antigen retrieval in a low pH citrate buffer using a microwave heat technique. Keratin staining in needle biopsies and total prostatectomies was unaffected. CONCLUSION: In summary, our results indicate the technique of transurethral resection results in a specific loss of keratin antigenicity. This limits the utility of anticytokeratin 34betaE12 in interpreting transurethral resections without the application of antigen retrieval.     

Reliability of histological malignancy grade,ER and HER2 status on core needle biopsy vs surgical specimen in breast cancer

Early determination of malignancy grade and biomarkers in primary breast cancer is important when planning the treatment with neoadjuvant therapy and breast‐conserving surgery. The aim of this study was to assess the reliability of malignancy grade on core needle biopsies, and to compare the concordance of ER and HER2 status on core needle biopsies vs surgical specimens. Eighty‐nine patients with invasive ductal or lobular carcinoma were included. Malignancy grade was upgraded by one degree in 23.0%. The mitotic count had most impact on the malignancy grade, and may be underestimated on core needle biopsies compared with surgical specimens. ER status was concordant in core needle biopsies and surgical specimens in 98.0%, but should be repeated when doubtfully negative. HER2 status was concordant in 84.0% prior to FISH‐HER2. Including FISH‐HER2 data, the core needle biopsies showed a final total concordance of 95.4%. In conclusion, ER and HER2 are useful markers in core needle biopsies, providing a reliable base for preoperative decisions in neoadjuvant chemotherapy, and may be omitted on surgical specimens with certain precautions and exceptions. Determination of malignancy grade should be repeated on surgical specimens, and one should be aware of underestimation on core needle biopsies.     

Expression and activity of matrix metalloproteinases-2 and -9 in serum,core needle biopsies and tissue specimens of prostate cancer patients

Prostate cancer is the most common cancer in men and second in the cancer-related frequency of mortality. Matrix metalloproteinases (MMPs) are involved in tumor invasion and metastasis in various malignancies. MMP-2 and MMP-9 are capable of digesting collagen type IV. Numerous studies have demonstrated an association between increased MMP-2 and -9 expression and tumor progression in various tumors. In this study, the expression and activities of MMP-2 and -9 were assessed in serum probes and tumor tissue from core needle biopsies and radical prostatectomies of 97 patients. MMP-2 and -9 serum expression was analyzed in a subgroup of 31 patients. MMP-9 serum expression was significantly increased in tumor patients and correlated with tumor grade. In contrast, the MMP-9 tissue expression and activity revealed no significant correlations to tumor stage or grade. The MMP-2 activity, however, showed a positive correlation for MMP-2 with tumor stage. Increased activity was predominantly detected in advanced tumor stages. Immunohistochemical analysis of MMP-2 expression demonstrated a positive association with tumor grade in prostatectomy specimens. The relative expression rates in biopsies matched in 65% with those of the prostatectomies. Detection of MMP-2 in core needle biopsies seems not to be a helpful marker for diagnostic purposes.     

Atypical ductal hyperplasia in breast core needle biopsies. Correlation of size of the lesion, complete removal of the lesion, and the incidence of carcinoma in follow-up biopsies.

We reviewed the results of all breast core needle biopsies with a diagnosis of atypical ductal hyperplasia (ADH) or atypia not otherwise specified and subsequent excisional biopsies for a 50-month period and correlated the results. Of 3,026 biopsies, 216 were diagnosed as ADH or atypia not otherwise specified, and subsequent resection was available for 105. After review, 95 qualified as ADH. Subsequent resection showed ductal carcinoma in situ (DCIS) in 13 excisions, ADH in 31, lobular carcinoma in situ in 6, and benign proliferative lesions in the remaining 45. In none of the 8 biopsies in which DCIS was found and radiographs were available for review was the radiographic lesion entirely removed. For comparison, the incidence of carcinoma in resections done for a diagnosis of DCIS, low or intermediate grade (solid, cribriform, or micropapillary type), on core needle biopsy was significantly greater (8 of 10 cases). However, the size of the lesions diagnosed as carcinoma also was significantly greater than that of the lesions diagnosed as ADH, and in none of the 8 biopsies with DCIS at excision was the lesion entirely removed at the time of biopsy. The incidence of carcinoma in excisional biopsies done for a diagnosis of ADH in core needle biopsies in our institution is relatively low, while the incidence of ADH is relatively high. Possible reasons for this include total removal of small lesions at the time of biopsy and use of the diagnostic term ADH for lesions that are not associated with coexistent DCIS.     

Comparison of core oestrogen receptor (ER) assay with excised tumour: intratumoral distribution of ER in breast carcinoma

AIMS: The use of the H score (involving the assessment of intensity and distribution of positivity) on sections stained for the oestrogen receptor (ER) by immunocytochemistry (ICC) allows different samples to be compared and detailed correlations to be made between hormone receptor expression and morphology. This study assessed the reliability of core biopsy in predicting ER expression in the same tumour excised later at treatment. The distribution of ER within excised tumours was investigated. METHODS: The distribution of ER positivity was investigated in 51 diagnostic core biopsies and across the diameter of 51 subsequently excised tumours in a field by field (magnification, x40; field diameter, 0.4 mm) assessment using the semiquantitive H scoring system. RESULTS: The ER H score in diagnostic core biopsy was significantly higher (p = 0.05, paired rank test; overall mean, 130; n = 51) than the mean in the corresponding excised tumour (mean, 110; n = 51). There was a significant downward trend in ER positivity from the periphery of tumours towards the centre (p = 0.001). The reduction of ER positivity was 6 H score units (2%)/mm. If core biopsies were orientated with the tumour edge at one end no change in ER positivity with field number along the length of the core could be demonstrated. CONCLUSIONS: ER estimation in core biopsies correlated well with expression in tumours but ER expression was higher in the core biopsies than in the excised tumours. ER expression was higher at the periphery of tumours than at the centre. The higher ER expression in cores may reflect the higher chance of sampling the peripheral part of a tumour using a needle core.     

纵隔芯针活检的病理诊断

目的 提高纵隔芯针穿刺组织的诊断准确性并做出具体分类。方法 用光镜、免疫组织化学抗生物素蛋白-生物素复合物法(ABC法)回顾性观察65例纵隔穿刺组织的形态和免疫组织化学表型,利用聚合酶链反应(PCR)检测部分非霍奇金淋巴瘤的基因重排状况,并随访。结果 本组标本镜下主要由不同比例的上皮样细胞、淋巴样细胞和纤维组织组成,包括21例淋巴瘤、20例肺癌、14例胸腺瘤、4例胸腺癌、3例精原细胞瘤、1例慢性炎症。2例因穿刺组织过少,无法诊断。本组淋巴瘤依不同类型可表达CD20、CD3、末端脱氧核苷酸转移酶(TDT)、CD30、D15或上皮膜抗原(EMA);除3例肺小细胞癌细胞角蛋白(CK)阴性外,17例肺癌均表达CK;10例肺和1例胸腺小细胞癌突触素、嗜铬粒素A(CgA)、神经元特异性烯醇化酶(NSE)均阳性,CD5阴性;3例肺腺癌甲状腺转录因子阳性,CD5阴性;14例胸腺瘤CK、CD3或CD20可阳性;3例胸腺癌表达CK和CD5;3例精原细胞瘤胎盘碱性磷酸酶阳性、CK阴性。5例淋巴母细胞性淋巴瘤T细胞型的T细胞受体B链的编码基因存在重排,3例大B细胞淋巴瘤和1例大细胞间变B细胞淋巴瘤存在免疫球蛋白重链编码基因的重排。结论 纵隔穿刺组织的镜下诊断需结合临床和影像资料,选择适当的免疫组织化学套餐,才能提高确诊率,并可对有疑问的非霍奇金淋巴瘤病例进行克隆性分析。     

Carcinoma extent in prostate needle biopsy tissue in the prediction of whole gland tumor volume in a screening population

Increasing prostate tumor volume has been shown to correlate with numerous adverse prognostic indicators for patients with prostate carcinoma The ability to predict tumor volume from pretreatment parameters is potentially critical in the stratification of patients for different management strategies. We assessed the capacity of preoperative variables to predict tumor volume in 100 men diagnosed with prostate cancer in a prostate-specific antigen (PSA)-based screening program. Preoperative information included total serum PSA concentration and needle biopsy tissue variables, including Gleason score, number of positive cores, linear extent of carcinoma in millimeters, greatest percentage of carcinoma (in a single core), total percentage of carcinoma (all cores), presence of perineural invasion, and percentage of high-grade carcinoma. The postoperative end point was total tumor volume in radical prostatectomy tissue, calculated by image analysis. We determined independently significant factors and generated a predictive modelfor whole gland tumor volume. Total tumor volume was related significantly in multivariate analysis to 3 preoperative variables: linear extent of carcinoma, exponential number of positive cores, and serum PSA. A predictive model generated based on these 3 variables accounted for only 65% of the natural deviance of the data owing to data-point scatter for individual patients, suggesting that additional variables are needed to more accurately predict tumor volume. Findings highlight the importance of reporting quantitative measures of tumor amount in prostate needle biopsy specimens; several measures of tumor extent (vs 1 measure) provide maximal information on prostate cancer size.     

Thymoma with extensive necrosis: a case report and review of literature

Thymoma exhibiting extensive necrosis is extremely rare and remains a diagnostic challenge for both radiologists and pathologists. We describe such a thymoma in an 18-year-old African-American female. Core needle biopsy contained only necrotic tumor tissue. A well-encapsulated 13-cm anterior mediastinal thymoma with extensive necrosis and areas of hemorrhage was resected. Microscopically, the thymus was almost completely replaced by tumor composed of plump epithelial cells with vesicular nuclei and prominent nucleoli in a background of lymphocytes and extensive necrosis. The clinical, immunohistochemical and diagnostic pitfalls of this tumor in core needle biopsies is discussed.     

Papillary lesions of the breast—accuracy of core biopsy

Tse G M, Tan P‐H, Lacambra M D, Jara‐Lazaro A R, Chan S‐K, Lui P C, Ma T K F, Vong J S, Ng D C H, Shi H‐J & Lam W W
(2010) Histopathology 56 , 481–488 Papillary lesions of the breast—accuracy of core biopsy Aims: To assess the accuracy of diagnosing papillary breast lesions in core needle biopsy. Methods and results: One hundred biopsy specimens of papillary breast lesions were reviewed and compared with the final excisional diagnoses. The discordant biopsy specimens were stained for oestrogen receptor (ER), cytokeratin (CK) 14 and p63, and these specimens were reclassified based on these results. The overall core biopsy accuracy, false‐positive and false‐negative rate were 79%, 5% and 16%, respectively. A benign core biopsy specimen diagnosis gave a false‐negative rate of 10%, and malignant core biopsy specimen diagnosis did not give any false‐positive results. Using homogeneous ER (epithelial), positive CK14 (epithelial) and p63 (myoepithelial) immunoreactivity as benign criteria, the discordant rate was reduced by 30% and 69% when using all three or two of these three criteria for diagnosis. However, false‐positive and ‐negative cases could not be totally eliminated. Conclusions: Immunohistochemistry is helpful in core biopsy diagnosis of papillary breast lesions, but some cases remained misdiagnosed.     

Pelvic cavity malignant solitary fibrous tumor with dedifferentiation and multifocal cytokeratin expression

Pelvic cavity small-sized malignant solitary fibrous tumors are rare. Surgeons easily misjudge these tumors as benign lesions, and they are usually resected by laparoscopic surgery. When accompanied by dedifferentiation, malignant solitary fibrous tumors are difficult to diagnose by pathologists. Here, we describe a challenging case. A 47-year-old man was accidentally found to have a pelvic mass after three months. Surgeons assumed a diagnosis of a benign tumor according to the Computed Tomography and Ultrasonography reports. The patient underwent laparoscopic surgery to resect the tumor. After the operation, the patient was diagnosed as having a malignant solitary fibrous tumor with dedifferentiation. The patient had a recurrence one year later. This pelvic cavity malignant solitary fibrous tumor was a rare case because of its dedifferentiation and cytokeratin expression. The expression of cytokeratin and the absence of vimentin and CD34 were pitfalls to diagnosis. In this case, there was still a high amount of malignancy despite the small size of the tumor. Clinical image and pathologic multidisciplinary analysis and core needle biopsies before surgery had a great effect on diagnosis and therapy of this disease. The case is a cautionary tale not only for pathologists but also for surgeons.     

Validation of cytokeratin 5/6 as an effective substitute for keratin 903 in the differentiation of benign from malignant glands in prostate needle biopsies

AIMS: Keratin 903 (also known as anti-cytokeratin antibody 34betaE12) is widely used to differentiate benign glands from malignant glands in prostate needle biopsies. However, it is subject to considerable staining heterogeneity. We sought to evaluate the use of cytokeratin 5/6 (CK5/6) as an effective alternative to K903 in the evaluation of prostate needle biopsies in clinical practice. METHODS AND RESULTS: Thirty Hollandes-fixed prostate needle biopsies were randomly selected over a period of 2 months from the surgical specimens accessioned over that period of time. Twelve cases had diagnosed prostatic adenocarcinoma (Gleason scores 3 + 3, 3 + 4 and 4 + 4) and the remaining cases (n = 18) were negative for carcinoma. Four sequential sections were stained with H&E (x2), K903, and CK5/6. Care was taken to preserve tissue so that matching glands were evaluated on all four sections. All cases were run routinely over a period of 3 weeks on a daily basis with matching positive controls. All slides were evaluated in a blinded fashion independently by two pathologists using a semiquantitative analysis of staining: <25%, 25-50%, 50-75%, >75% and >95% of benign glands (verified on H&E). Cases that showed no staining were repeated to ensure no false negatives. Both observers agreed with respect to percentage of staining in 96% of the cases. Twenty-nine of 30 cases (97%) showed staining in >95% of benign glands with CK5/6. In contrast, K903 staining was seen in <50% of benign glands in five of 30 (17%), 50-75% in nine of 30 (30%), and >75% in 10 of 30 (33%), with only two cases (7%) showing >95% staining for K903. In four cases (13%) the K903 failed to stain any tissue even after repeat staining. K903 was conspicuously negative in atrophic glands in three of 30 cases (10%). Neither K903 nor CK5/6 stained malignant glands. Using a cut-off of >75% staining in benign glands the sensitivity of CK5/6 and K903 was 97% and 40%, respectively. CONCLUSIONS: CK5/6 has superior sensitivity and reliability compared with that of K903 when evaluating routine prostate needle biopsies, including improved staining of atrophic prostatic glands. While K903 is traditionally used to differentiate benign glands from malignant glands, these results support the use of CK5/6 as an effective and reliable substitute for K903 in routine clinical practice.     

Phyllodes tumours of the breast - differentiating features in core needle biopsy

Tsang A K H, Chan S K, Lam C C F, Lui P C W, Chau H H L, Tan P H & Tse G M
(2011) Histopathology  59 , 600–608 Phyllodes tumours of the breast – differentiating features in core needle biopsy Aims: To investigate the usefulness of histological features in the differentiation of fibroepithelial lesions of the breast (phyllodes tumours and fibroadenomas) in core needle biopsies. Methods and results: Forty‐nine and 69 excision‐proven core biopsies of phyllodes tumours and fibroadenomas, respectively, were evaluated histologically for stromal cellular changes (overall stromal cellularity, variability in stromal cellularity, stromal cell pleomorphism, and mitotic count) and stromal architectural changes (stromal overgrowth, fragmentation of the cores, and fat in stroma). In core needle biopsies of phyllodes tumours, overall stromal cellularity, stromal cell pleomorphism and mitotic count showed good correlation with excisions. In phyllodes tumours, core needle biopsy diagnosis showed increased certainty with increasing degree of malignancy. Core biopsies of phyllodes tumours showed more consistent stromal cellular changes (overall stromal cellularity, variability in stromal cellularity, stromal pleomorphism, and mitotic count) than those of fibroadenomas. These parameters were also useful for differentiation between benign and malignant fibroepithelial lesions. For grading phyllodes tumours, stromal cell pleomorphism and mitotic activity were found to be helpful. Conclusions: In the core biopsy assessment of phyllodes tumours, evaluation of selected histological parameters, particularly those pertaining to stromal cellular changes, is helpful.     

MIB1 labeling index as an indicator of chemoresponse in carcinoma of the breast.

In this study, we determined the extent of variation in proliferative markers and hormone receptor status in breast carcinoma between core biopsies and subsequent resections, and determined the impact of clinical and histologic parameters on such variation. We performed a paired comparison of biomarkers in 87 core biopsies and subsequent resections of breast carcinomas in patients with and without preoperative chemotherapy. The markers included estrogen receptor, progesterone receptor, Her2/neu, DNA ploidy (diploidy versus nondiploidy), DNA index (difference of > or = 0.5), and MIB1 labeling index (<15% vs. >15%). The tumor biomarkers were evaluated with standard IHC and scored by automated cellular imaging systems. The number of patients showing prominent changes were as follows: ploidy, 12; DI, 15; ER, 6; PR, 15; MIB1, 17; and Her2/neu, 15. Seventeen of 87 patients sustained a significant change in MIB1 index (above or below 15%). The patients who received chemotherapy had a larger proportion with a change in MIB1 status (P < 0.05). DI showed a similar trend, although it was not statistically significant. Of the patients with MIB1 values higher in biopsy specimens, a majority showed values to decrease below 15%. MIB1 index reduction by greater than 25% was seen in 8 of 16 (50%) cases with chemotherapy, compared with only 3 of 32 (9%) without chemotherapy. MIB1 and DNA index values postchemotherapy can be a useful measure of chemoresponse. Our study underscores the need to perform prognostic markers on both biopsy and subsequent resections, especially in the setting of preoperative chemotherapy.     

Effect of neoadjuvant chemotherapy on the expression of hormone receptors and Ki67 in Chinese breast cancer patients: A retrospective study of 525 patients

This study was designed to investigate the effect of neoadjuvant chemotherapy on the expression of hormone receptors and Ki67 in Chinese female breast cancer patients. The expression of estrogen receptor (ER), progesterone receptor (PR) and Ki67 among 525 neoadjuvant chemotherapy cases was studied by immunohistochemistry. Differences between specimens made through preoperative core needle biopsy and excised tissue biopsy were observed. The positive rates of ER, PR and Ki67 in core needle biopsy and excised tissue biopsy were 65.3% and 63.2%, 51.0% and 42.6%, 65.6% and 43.4%, respectively. The expression of ER, PR and Ki67 in core needle biopsy and excised tissue biopsy had no statistically significant difference. However, after neoadjuvant chemotherapy, the discordance rates of ER, PR and Ki67 were 15.2% (79/521), 26.9% (140/520) and 44.8% (225/502), respectively. The ER, PR and Ki67 status changed from positive to negative in 7.5% (39/521), 13.3% (69/520) and 21.1% (106/502) of the patients, whereas ER, PR and Ki67 status changed from negative to positive in 7.7% (40/521), 13.6% (71/520) and 23.7% (119/502) of the patients, respectively. These results showed that the status of some biomarkers changes after neoadjuvant chemotherapy and biomarker status needs to be reexamined to optimize adjuvant systemic therapy and better prognosis assessment.     

Value of core needle biopsy in the diagnosis of soft tissue tumours

We performed a prospective study to determine the accuracy of core needle biopsy in the diagnosis and grading of soft tissue tumours and to study the morbidity of core needle biopsy. Forty one cases of soft tissue tumours, 24 of them malignant and 17 benign, were biopsied with an 18G core needle. Core needle biopsy reports were compared with the final histopathological report after definitive procedure or incisional biopsy. 85.3% of core biopsies yielded adequate sample. Core needle biopsy had a sensitivity of 90%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 88.23%. Overall accuracy for diagnosis of malignancy was 94.28%, 77.7% of tumours were correctly subtyped and none of them were histologically graded. There was no immediate complication of haemorrhage in any of the cases. Thus, we conclude that core needle biopsy is equivalent to incisional biopsy in diagnostic accuracy and being simple, less expensive and unlikely to compromise further management, can be used in place of open biopsy of soft tissue tumours.     

Intraoperative pathologische Sofortuntersuchung in der Mammachirurgie

In breast surgery intraoperative frozen sections for the diagnosis of malignancy has lost impact and has largely been replaced by preoperative core needle biopsies. Nevertheless, there is still need for immediate pathological investigation of native breast tissue during surgery due to three reasons: (1) macroscopic and microscopic evaluation of resection margins, (2) the histological analysis of sentinel lymph nodes in order to circumvent secondary axillary surgery and (3) the preparation of native tissue for tumor banking or measurement of biomarkers. Because histology provides only a facultative component of immediate pathological examination of breast specimens during surgery, the term frozen section does not seem to be appropriate anymore. Intraoperative evaluation of resection specimens by pathologists provides surgically relevant information immediately, guarantees standardized preparation and fixation of specimens and enables tissue banking of native tissue for assessment of biological markers.     

Variation in reporting of cancer extent and benign histology in prostate biopsies among European pathologists

It is not known how uropathologists currently report histopathological features of prostate biopsies such as core length, tumor extent, perineural invasion, and non-tumor-associated features such as inflammation and hyperplasia in needle biopsies. A web-based survey was distributed among 661 members of the European Network of Uropathology. Complete replies were received from 266 pathologists in 22 European countries. Total core lengths were reported by 64 %. The numbers of cores positive for cancer was given by 79 %. Linear cancer extent was reported by 81 %, most often given in millimeters for each core (53 %) followed by the estimation of percentage of cancer in each core (40 %). A gap of benign tissue between separate cancer foci in a single core would always be subtracted by 48 % and by 63 % if cancer foci were minute and widely separated. Perineural invasion was reported by 97 %. Fat invasion by tumor was interpreted as extraprostatic extension by 81 %. Chronic and active/acute inflammation was always reported by 32 and 56 % but only if pronounced by 54 and 39 %, respectively. While most (79 %) would never diagnose benign prostatic hyperplasia on needle biopsy, 21 % would attempt to make this diagnosis. Reporting practices for prostate biopsies are variable among European pathologists. The great variation in some methodologies used suggests a need for further international consensus, in order for retrospective data to be comparable between different institutions.     

Histological correlation of mammographically detected microcalcifications in stereotactic core biopsies

The aims of this study were to assess the value of specimen radiographs of stereotactic core biopsy, the usefulness of measuring size of calcifications on tissue sections, whether demonstration of calcifications in tissue sections alters the pathological diagnosis when specimen radiograph demonstrates calcifications, and to correlate these assessments with diagnostic outcome. A total of 301 core biopsies from 266 women with 274 mammographically suspicious areas of calcifications were examined. Core biopsies (five cores per procedure) were obtained stereotactically using a 14-gauge needle in an automated Biopty gun. Prior to processing of the tissue, 214 core biopsy specimens from 193 women with 197 lesions were radiographed. Of the 301 core biopsies, 56 (19%) were diagnosed as malignant, 15 (5%) were diagnosed as atypical ductal hyperplasia and 230 (76%) contained benign breast tissue. Of the core biopsies diagnosed as benign, 160 (70%) had specimen radiography prior to processing. Of these, 109 (69%) core biopsies showed calcifications on specimen radiographs. In 96 (88%) of these core biopsies, calcifications measuring > 100 microm were found on the initial tissue sections. In 11 (10%) further deeper sections were required to detect calcifications > 100 microm; however, this did not result in a change of the pathological diagnosis. Two of the 109 (1.8%) "benign" core biopsies, which contained tissue calcifications > 100 microm and at that time were considered representative of the mammographic lesion, have had a malignant outcome on clinical and mammographic follow-up ranging from 2.4 to 7.5 years. Of the 51 (31%) core biopsies where calcifications were not seen on specimen radiographs, histological calcifications were not found in 34 (67%) core biopsies, whereas in 17 (33%) core biopsies, calcifications measuring < 100 microm were found. All of these core biopsies were considered non-diagnostic and therefore not representative of the lesion targeted. Five (9.8%) of these cases had a malignant outcome with either immediate rebiopsy or excision. Accurate diagnosis of all mammographic lesions requires radiological-pathological correlation. This study shows that the presence of calcifications on the specimen radiograph and the demonstration of tissue calcifications > 100 microm are an essential and highly reliable part of core biopsy assessment for mammographically "suspicious" calcifications. Nevertheless, lesions with "highly suspicious" calcifications on mammography should be considered for excision even if the core biopsy diagnosis is benign and calcifications > 100 microm are present.     

Use of Electron Microscopy in Core Biopsy Diagnosis of Oncocytic Renal Tumors

The distinction between oncocytoma and chromophobe renal cell carcinoma, important clinically, may be challenging, especially as the tissue sample size decreases. Ancillary studies can be helpful, although subject to interpretation and sample variability. The aim of this study was to examine the value of electron microscopy in differentiating between oncocytoma and chromophobe renal cell carcinoma on formalin fixed paraffin embedded needle core biopsies. Twenty renal needle core biopsies were evaluated. Despite formalin fixation and paraffin embedding, the classic ultrastructural features of these neoplasms were retained, revealing 80% sensitivity and 100% specificity by initial work-up.