Comparison of the molecular profiling of core biopsy with surgical specimens in breast cancers and the effect of neoadjuvant therapy on the same - A North Indian study.

Aims and Objectives: The purpose of this study was to determine the concordance of core needle biopsy (CNB) and surgical specimens for determining the molecular profiling and to observe the changes in the same after neoadjuvant chemotherapy. Materials and Methods: This was a cross-sectional study over a period of one year on 95 cases. Immunohistochemical (IHC) staining was done as per the staining protocol in a fully automated BioGenex Xmatrx staining machine. Results: On CNB, estrogen receptor (ER) positivity was seen in 58 out of 95 cases, comprising 61% of the total, and on mastectomy, it was positive in 43 (45%) cases. Progesterone receptor (PR) positivity was seen in 59 (62%) cases on CNB and 44 (46%) cases on mastectomy. Total 7 (7%) were human epidermal growth factor receptor 2 (HER2)/neu positive on CNB and 8 (8%) on mastectomy, respectively. There were 15 (15.7%) that showed discordant results after neoadjuvant therapy. Estrogen status changed from negative to positive in 1 (7%) case and positive to negative in 14 (93%) cases. Progesterone status changed from positive to negative in all 15 cases (100%). There was no change in the HER2/neu status. The agreement of hormone receptor status between CNB and subsequent mastectomy in the present study was found to be substantial (kappa value for ER, PR, and HER2neu as 0.608, 0.648, and 0.648, respectively. Conclusion: IHC is a cost-effective method to assess hormone receptor expression. This study shows that ER, PR, and HER2/neu expression in CNB should be reassessed in excision specimens for the better management of endocrine therapy.

Fine-Needle Aspiration Cytology versus Core-Needle Biopsy for Breast Lesions: A Dilemma of Superiority between the Two.

INTRODUCTION: Core-needle biopsy (CNB) is a minimally invasive procedure used in preoperative diagnosis of breast lumps. It has been seen that in few years, the CNB seems to be replacing the fine-needle aspiration cytology (FNAC), although no study had yet conclusively proved a superiority of one over the other. AIMS AND OBJECTIVES: The aim of this study was to study the cytohistological spectrum of palpable breast lesions and to evaluate the diagnostic accuracy of FNAC versus CNB for breast lesions. MATERIALS AND METHODS: The study was a cross-sectional study conducted in the Department of Pathology and Surgery, over a period of 1 year in 152 patients. All the patients were subjected to FNAC and CNB. Cytosmears were stained with May-Grunwald Giemsa and hematoxylin and eosin was done on CNB and excision biopsy (EB) specimens. Sensitivity and specificity were calculated in percentage with 95% confidence interval with reference to CNB/surgical specimens. Kappa statistics were used to compare the level of agreement between FNAC versus CNB and CNB versus surgical specimens. RESULTS: A total of 152 patients were taken for FNAC and CNB. EB was performed in only 104 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FNAC verses CNB in correlation with subsequent histopathology were found to be (93.40 vs. 94.06%), (97.50 vs. 100.00%), (99.00 vs. 100.00%), (84.78 vs. 33.33%), and (94.52 vs. 94.23%), respectively. CONCLUSION: CNB has overcome the pitfall of FNAC but CNB cannot replace FNAC but both procedures are complementary to each other.