[Preoperative diagnosis with stereotactic biopsy is a good predictor of breast cancer in radiologically non-benign breast lesions]. / Preoperatieve diagnostische stereotactische biopsie goede voorspeller van mammacarcinoom bij radiologisch niet-benigne mamma-afwijkingen.

OBJECTIVE: To evaluate histological needle biopsy in breast lesions classified radiologically as 'non-benign'. DESIGN: Prospective, descriptive. SETTING: Hospital Velp, Velp, the Netherlands. METHODS: 232 women with an 'uncertain', 'suspicious' or 'malignant' result of mammography, if necessary supplemented by echography, were subjected to histological biopsy from a breast between 1 January 1994 and 1 January 1997. The earlier biopsies were made with a 16 Gauge (G) needle, those after April 1996 with a 14 G needle, as a rule under stereotactic control. In principle, operation was performed after a positive result. Concerning the women operated after the biopsy, the results of the histological examinations were compared in a 2 x 2 table. RESULTS: 165 of the 232 patients (71%) had breast cancer. Of the 59 patients classified roentgenologically as 'uncertain', 15 (25%) had breast cancer, of the 'suspicious' cases this ratio was 44/67 (66%) and of the 'malignant' results it was 106/106 (100%). Operation was performed in 186 women. The biopsy findings and the surgical preparation were in agreement in 169 patients (91%). The sensitivity of the stereotactic biopsy was 90%, its specificity 93%. One woman was over-treated (axillary lymph node resection) because of a biopsy classified as malignant performed on a rare tumour ultimately diagnosed as 'adenomyo-epithelioma with epithelial atypia'. The proportion of false-negative results was 36%. The predictive value of a positive result was 99%, that of a negative result 63%. CONCLUSION: A diagnostic stereotactic biopsy after roentgenological classification based on mammography and echography had a good predictive value regarding the probability of breast cancer.

Value of a panel of antibodies to identify the primary origin of adenocarcinomas presenting as bladder carcinoma.

AIMS: Adenocarcinomas may arise primarily from the urinary bladder, but secondary involvement from adenocarcinomas arising in adjacent organs is more common. In the present study we tried to differentiate primary urinary bladder adenocarcinomas from adenocarcinomas arising from the surrounding organs, based on their antigen profiles in routinely processed, paraffin-embedded tissue specimens. We analysed the staining results using stepwise linear discriminant analysis. METHODS AND RESULTS: We investigated the usefulness of a panel of antibodies against cytokeratin 7, E48, cytokeratin 20, PSA, PSAP, CEA, vimentin, OC125 and HER-2/neu, to discriminate primary bladder adenocarcinoma from adenocarcinomas arising from the prostate, urachus, colon, cervix, ovary and endometrium. In the differential diagnosis with urinary bladder adenocarcinoma, an overall correct classification was reached for 77% and 81% of urachal and colonic carcinomas, respectively, using CEA, for 93% of prostatic adenocarcinomas using PSA, for 82% and 70% of cervical and ovarian adenocarcinomas, respectively, using OC125, and for 91% of endometrial adenocarcinomas using vimentin. Adding other antibodies did not improve the classification results for any of these differential diagnoses. CONCLUSIONS: For the surgical pathologist, a panel of antibodies consisting of CEA, PSA, OC125 and vimentin is helpful to differentiate primary urinary bladder adenocarcinomas from adenocarcinomas originating from prostate and endometrium, less helpful in differentiation with urachal carcinoma, and not helpful in differentiation with colonic, cervical and ovarian carcinoma.

[Little clinical relevance in routine pathological examination of uteri removed in women with prolapse symptoms]. / Weinig klinische relevantie van routinematig pathologisch onderzoek van uteri verwijderd bij vrouwen met prolapsklachten.

OBJECTIVE: To study the clinical usefulness of pathological examination of the uteri removed from women with complaints of prolapse of the uterus. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynaecology and Department of Pathology of the Medical Centre Alkmaar, the Netherlands. METHODS: Between June 1st 1990 and August 31st 1994, 221 women underwent vaginal hysterectomy because of prolapse of the uterus. At the SIG Zorginformatie national reference data were collected from the pathology archives (PALGA). RESULTS: No malignancy or carcinoma in situ of cervix or endometrium was found in the 221 women; 7 times a cervical intraepithelial neoplasia (CIN) 1 with free hysterectomy resection margins was seen. In the national data of 5,739 comparable operated women a malignancy was found in 9 (0.16%) patients while 10 (0.17%) specimens showed a carcinoma in situ; in one of these cases an adenocarcinoma of the endometrium had not been removed completely in the area of the fallopian tube. The unexpected finding of a cervical or uterine malignancy at histological examination is extremely rare (1:717 hysterectomies nationwide) if the uterus was surgically removed because of prolapse. CONCLUSION: The idea of omitting histological examination under certain conditions needs further evaluation. A prospective study should ascertain under what circumstances, e.g. the combination of a normal menstrual bleeding pattern, or absence of postmenopausal bleeding, with a normal cervical smear preoperatively, and normal macroscopic appearance, judged by the pathologist, microscopic examination can safely be omitted.

OV-TL 12/30 (keratin 7 antibody) is a marker of glandular differentiation in lung cancer.

The immunoreactivity of OV-TL 12/30, a monoclonal antibody to keratin 7 was investigated on paraffin-embedded human lung cancer tissues of 61 patients. A modified AEC-immunoperoxidase method with pepsin pre-digestion was used. In normal lung tissue keratin 7 was found in bronchial and bronchiolar epithelium, pneumocytes and compound glands. Squamous metaplasia of the bronchial tree was negative. All 24 squamous cell carcinomas were negative irrespective of grade of differentiation. All differentiation grades of 20 adenocarcinomas including bronchioalveolar carcinomas were positive. Since six large cell anaplastic carcinomas did not react with keratin 7 antibody these tumours are considered to be of squamous cell rather than adenocarcinomatous origin. Small cell anaplastic carcinomas were negative in 10 of 11 cases. Our study demonstrates that this keratin 7 antibody is useful in differentiating between squamous cell carcinoma and adenocarcinoma of the lung and it may be particularly useful in making the correct diagnosis in small lung biopsy specimens.

Survival of patients with malignancy-associated effusions.

For a better understanding of the prognosis after the onset of a malignancy-associated effusion in patients known or subsequently shown to have cancer, survival time was compared with the findings and the date of the first cytologic diagnosis of an effusion. The number of patients studied was 254; 171 had a pleural and 83 a peritoneal effusion. The average survival time was 25.5 weeks, which was about equal for both sites of effusions. After two years, only 6% of all patients were alive. When the cytologic diagnosis of the effusion was "malignant," only 4% survived after two years; when the cytologic diagnosis was "suspicious for malignancy" and "nonmalignant," these figures were 5% and 7%, respectively. This indicates that a cytologic diagnosis of benign or nonmalignant is not a good indicator of a better prognosis in cancer patients for whom benign causes of the effusion have been excluded. There appeared to be a prognostic relationship between the length of the interval from the initial diagnosis of cancer to the time of examination of the first sample of the effusion: a longer interval was correlated with a better survival. When survival time was viewed in relation to therapy, patients whose pleural effusions were only treated by aspiration were found to have a particularly short average survival (13.9 weeks).

The interval between the diagnosis of malignancy and the development of effusions, with reference to the role of cytologic diagnosis.

An analysis was made of the time lapse between the diagnosis of malignancy and the development of an effusion in relation to the sex and age of the patients and the site of the primary malignancy. The total number of patients studied was 254; of these, 171 patients had a pleural and 83 patients a peritoneal effusion. In the total group, sex distribution was two men to three women: about equal in the pleural effusion group and about two men to nine women in the ascites group, with the latter ratio reflecting the large number of primary malignant processes in the breast and ovaries. The average age at the time of the effusion, whether it was located in the pleural or in the peritoneal cavity, was about 55 years. This figure was roughly 60 years for men and 51 years for women. The nine-year average age difference between sexes can be explained by the size of the four largest groups of different primary malignant localizations and their sex distribution. The interval between the discovery of the primary malignancy and the first fluid sample was longer for patients with a pleural effusion (average of 77.0 weeks) than for patients with ascites (average of 54.5 weeks). The longest interval was seen in the breast carcinoma group, with the shortest interval in lung carcinoma patients. The interval was significantly longer for women, being 111.9 weeks for pleural effusions and 57.9 weeks for ascites (average for both sites of 88.7 weeks). In 30.7% of the patients, the primary malignancy was discovered at the same time or later than the effusion; in patients with lung cancer, a strikingly higher percentage of 53.0% was found. In this respect, the cytologic diagnosis of effusions is of great importance not only for the detection and proper identification of a malignant process but also as an indicator of the life expectancy of a patient.

Quantitative light microscopy of atypical mesothelial cells and malignant cells in ascitic fluid.

Light microscopic cytologic diagnosis of pleural and peritoneal effusions--specifically, the differentiation between atypical or reactive mesothelial cells and malignant cells--remains a problem. During the past several years, various labor-intensive special techniques have been used to obtain a better understanding of the morphology of these cell types. The present study, performed in part to provide a basis for developing more advanced quantitative cytologic techniques, employed visual light microscopic cytometry using an ocular micrometer on 750 malignant and 750 atypical mesothelial cells at a magnification of 1,000X. Our results statistically confirmed the importance of diagnostic features used in routine cytologic evaluation. In addition to the previously reported differences between cellular, nuclear and nucleolar size in malignant cells and atypical mesothelial cells in effusions, the percentage of irregular nucleoli was shown to be an important differential feature, averaging 58.8% in malignant cells as compared with 6.6% in atypical mesothelial cells.