Trends in pre-operative needle biopsy use in invasive breast cancer diagnosis: a Dutch nationwide population study.

INTRODUCTION: In recent decades, the use of pre-operative needle biopsy for breast cancer diagnosis has shifted. There is also an increased demand for availability of predictive factors. This study aims to quantify these changes. MATERIAL AND METHODS: From the Dutch nationwide pathology database (PALGA), all reports on breast cancer for five periods of 3 months between 1996 and 2016 were retrieved. Reports were categorised using automatic recognition of keywords. Classification was checked manually for the first 200 reports per period. The first 100 resected cases in each period underwent detailed investigation. RESULTS: For automatic analysis 34,639 reports were retrieved. Accuracy was 98% compared to manual assessment. Fine needle aspiration cytology (FNAC) decreased from 77% (1996) to 58% (2001), 34% (2006), 25% (2011), and 17% (2016). For detailed assessment, 498 cases were analysed. Diagnostic surgical excision decreased from 24% in 1996 to 3% in 2016, cases with only cytology from 65% to 1%, respectively. Cytology and core needle biopsy (CNB) were combined in 21% of cases in 2016. Pre-operative availability of ER status increased from 3% in 1996 to 36% in 2006 and 78% in 2016 (as compared to 47%, 92%, and 97% for post-operative availability, respectively) and for HER2 status from 0% to 13% and 66% (as compared to 1%, 89%, and 96% for post-operative availability, respectively). CONCLUSION: Results suggest that nationwide, clinics prioritise reliability and availability of ER and HER2 status, replacing FNAC by CNB. However, for optimal treatment planning for all patients, availability of pre-operative receptor status warrants further improvement.

Modified Core Wash Cytology: A reliable same day biopsy result for breast clinics.

BACKGROUND: Fine Needle Aspiration Biopsy (FNAB), Core Needle biopsy (CNB) and hybrid techniques including Core Wash Cytology (CWC) are available for same-day diagnosis in breast lesions. In CWC a washing of the biopsy core is processed for a provisional cytological diagnosis, after which the core is processed like a regular CNB. This study focuses on the reliability of CWC in daily practice. METHODS: All consecutive CWC procedures performed in a referral breast centre between May 2009 and May 2012 were reviewed, correlating CWC results with the CNB result, definitive diagnosis after surgical resection and/or follow-up. Symptomatic as well as screen-detected lesions, undergoing CNB were included. RESULTS: 1253 CWC procedures were performed. Definitive histology showed 849 (68%) malignant and 404 (32%) benign lesions. 80% of CWC procedures yielded a conclusive diagnosis: this percentage was higher amongst malignant lesions and lower for benign lesions: 89% and 62% respectively. Sensitivity and specificity of a conclusive CWC result were respectively 98.3% and 90.4%. The eventual incidence of malignancy in the cytological 'atypical' group (5%) was similar to the cytological 'benign' group (6%). CONCLUSION: CWC can be used to make a reliable provisional diagnosis of breast lesions within the hour. The high probability of conclusive results in malignant lesions makes CWC well suited for high risk populations.

Long-term follow-up of axillary recurrences after negative sentinel lymph node biopsy: effect on prognosis and survival.

As axillary recurrence (AR) after a negative sentinel lymph node biopsy (SLNB) is rare, the prognosis of these patients is unknown. Since treatment paradigms for patients with breast cancer are shifting toward less axillary surgery, the number of ARs might increase. In this study, we evaluated primary and salvage treatment as well as long-term survival of patients diagnosed with an AR. A retrospective analysis of the cancer registry of 16 breast cancer units in the Netherlands was used to identify patients who developed an AR after a negative SLNB performed between 2002 and 2004. Using local hospital records we recorded primary patient-, tumor-, and treatment-characteristics, as well as salvage treatment. We identified 54 patients with an AR, median 30 months (range 3-79) after SLNB. Eighteen patients (33 %) were initially treated with breast conserving therapy, 15 of whom received external beam radiation therapy (EBRT). Thirty-three patients (61 %) did not receive adjuvant systemic treatment. In 45 of the 54 (83 %) patients, a salvage axillary lymph node dissection was performed showing a median of three positive nodes (range 1-24). Nine patients (17 %) were not treated surgically: three were treated with salvage EBRT and six with salvage systemic therapy only. At time of detection of the AR, a total of 7 patients (13 %) had proven distant metastases. After a median follow-up of 47 months (range 3-118), the 5-year "post-recurrence" distant metastasis free survival was 50 % and overall survival was 58 %. Significant negative predictors of survival were negative estrogen receptor (ER) status and receiving adjuvant chemotherapy at initial treatment. AR following a negative SLNB is associated with a 58 % 5-year OS. Prognostic factors are ER- primary tumor and receiving adjuvant chemotherapy as a part of initial treatment, reflecting an aggressive phenotype. Adequate regional and systemic salvage therapy constitute a chance for long-term survival after AR.