breast tumors diagnosed as papillary neoplasm by fnab dae-kyum kim, sang-uk woo, jeong-han kim,...
Post on 19-Jan-2016
216 Views
Preview:
TRANSCRIPT
Breast Tumors Diagnosed as Papillary Neoplasm by FNAB
Dae-Kyum Kim, Sang-Uk Woo, Jeong-Han Kim, Seok-Jin Nam, Yoon-La Choi1 , Young-Lyun Oh1 and Jung-Hyun Yang
Department of Surgery and 1Pathology, Samsung Medical Center,Sungkyunkwan University, School of Medicine
Introduction
• Papillary neoplasm (PN) of the breast
• Fine Needle Aspiration Biosy (FNAB)
• PN and FNABPN and FNAB
- It is difficult to determinate their malignancy (Jeffrey and Ljung 1994)- Several other breast lesions may have similar features and may be misclassified as PN by FANB (Kline et al 1986, Naran et al 1988, Bardales et al 1994)
Methods
• Breast tumors diagnosed as “PN” by FNAB at Samsung Medical Center between Oct. 1994 and May 2004
• Retrospective study for 66 patients who underwent surgery - Diagnostic accuracy - Malignancy- Radiologic malignancy and pathologic results
• Radiologic malignancyRadiologic benign; BIRAD 1~3Radiologic malignant; BIRAD 4~5
• Statistics t testChi-square or Fisher’s exact test
Results1. Pathologic results for PN on
FNAB
0
5
10
15
20
25
30
35
40
Pathology
PN Non PN
No. of patients
n=37 n=37 (56.1%)(56.1%)
n=29 n=29 (43.9%)(43.9%)
2. Tumor Size
0
0.5
1
1.5
2
2.5
3
PN Non PN
Size (cm)
1.5cm1.5cm 2.8cm2.8cm
P=0.001P=0.001
Mean Mean size= size= 2.1 cm2.1 cm
3. Pathologic Results of True PN (n=37)
Pathology No. of patients (%)Multiple papillomas (MP)* 18 (48.6)Solitary papilloma (SP) † 11 (29.7)Papillary DCIS (pDCIS) 4 (10.8)Invasive papillary ca (IPCA) 4 (10.8)
* Including 5 cases of MP+other tumors; 2 atypical ductal hyperplasia (ADH) , 1 non pDCIS, mucinous ca, 1 invasive ductal ca(IDC) † Including 3 cases of SP+other tumors; 2 non pDCIS, 1 IDC
4. Pathologic Results of non PN (n=29)
0
5
10
15
20
25
malignant tumor* benign tumor†
No. of patients
5 (17.2%)24 (82.8%)
*15 IDC, 9 DCIS
† 3 fibroadenoma, 1 fibrocystic disease, 1 phyllodes tumor
5. Malignant Neoplasm
0
5
10
15
20
25
PN non PN
malignant benign
No. of patients
n=16
(43.2%)
n=21
(56.8%)
n=24
(82.2%)
n=5
(17.2%)
p=0.001
6. Radiologic Malignancy and PN
0
5
10
15
20
25
Radiologicmalignant
Radiologic benign
PN non PN
No. of patients
n=15
(42.9%)
n=20
(57.1%)
n=22
(71.0%)
n=9
(29.0%)
p=0.027
7. Radiologic Malignancy and Pathologic Malignancy
0
5
10
15
20
25
30
Radiologicmalignant
Radiologic benign
malignant benign
No. of patients
n=30
(85.7%)
n=5
(14.3%)
n=10
(32.3%)
n=21
(67.7%)
p<0.001
8. Cases of Radiologic Benign but Pathologic Malignant Tumors
No. of patients (%)DCIS 5 ( 50.0)IDC 3 ( 30.0)IPCA 2 ( 20.0)Total 10 (100.0)
An invasive papillary carcinoma (Lt) and a papilloma with clustered papillary architecture, which are difficult to differentiate malignancy
Conclusions
• When FNAB suggests ‘Papillary Neoplasm’, even if a radiologic benign, surgical excision should be considered because of high possibility of malignant tumor
top related