The Bethesda system (BS) for reporting thyroid fine-needle aspiration (FNA), which classifies nodules as nondiagnostic (ND), benign (B), atypia/follicular lesion of undetermined significance (AUS/FLUS), suspicious for follicular neoplasm (SFN/FN), suspicious for malignancy (SFM), or malignant (M), uses clinically valuable management guidelines. The authors employed a similar in-house classification system (IS) for thyroid FNAs, using the categories of ND, B, suspicious follicular cells (SFC), follicular lesion/neoplasm (FL/FN), SFM, and M. The authors compared IS and BS, and assessed the utility of BS in clinical practice. A total of 581 nodules with cytological/histological follow-up were examined and indeterminate lesions by BS were reclassified. The sensitivity and specificity for malignancy using IS were similar to that of BS (77% vs 99%). However, when SFN/FN and SFM were both considered positive, the results for IS and BS were as follows: sensitivity, 85% versus 85%; specificity, 87% versus 94%; and diagnostic accuracy, 86% versus 90%, respectively. Discrepancies between cytological and histological data were evident in 35 cases among all categories of BS except AUS/FLUS. The rate of surgery for nonmalignant nodules was lesser (20% vs 9%) by BS. Among 34 AUS/FLUS cases with follow-up data, hypocellularity was the case in 11 (46%) nonneoplastic and 10 (100%) neoplastic nodules. The use of BS results in a lower rate of surgery for nonmalignant nodules even though patients with borderline cytopathologic features are still encountered. AUS/FLUS category can be separated into subgroups according to the factors causing difficulties in the interpretation. There is a need of accumulation of AUS/FLUS cases to do further evaluations and studies.

Objective: Patients with breast cancer with a pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) have a better prognosis than patients with residual disease. The aim of the current study was to identify predictors of pCR. Methods: This retrospective study included 388 patients treated with anthracycline-based NAC. Clinicopathological parameters were compared between the patients with and without pCR in breast and axilla. Results: Treatment consisted of FAC/FEC in 230 patients (59%), TAC in 39 (10%) patients and AC followed by docetaxel in 119 (31%). In all, 36 (9.3%) patients had pCR. In univariate analysis, age, tumor size, lymph node involvement, tumor grade (p = 0.077, n = 265), ER and HER-2 status (n = 213), lymphovascular invasion (LVI), type of chemotherapy and taxane-containing chemotherapy were associated with pCR. In multivariate analysis, ER negativity (p = 0.003), the absence of LVI (p = 0.009) and taxane-containing NAC (p = 0.026) were found to be significant indicators of pCR. Median follow-up time was 69 months. Progression-free survival was significantly improved in patients achieving pCR (p = 0.001). Conclusions: pCR is associated with a better outcome regardless of clinical and pathological parameters in breast cancer patients who receive NAC. The probability of pCR was higher in ER-negative, LVI-negative tumors and in patients treated with sequential taxane-containing chemotherapy.

Objective: We present histopathologic and immunohistochemical characteristics and differential diagnosis as well as possible pathogenetic mechanisms of benign nevus cell aggregates in five cases detected in axillary lymph nodes in patients operated for breast carcinoma. Material and Method: We examined axillary lymph nodes from 5 patients operated for breast carcinoma. between August 999 and january 2008. These lymph nodes were examined in detail with Hematoxylin and Eosin, anti-pancytokeratin, anti-s-00, and anti-Ki-67. Results: Of the lymph nodes with nevus cell aggregates, two were sentinel and three were non-sentinel lymph nodes of standard axillary dissection. All the lesions were small-sized and located in the lymph node capsule. Of these, two displayed nevus cells with cytoplasmic melanin pigment. benign morphologic features of the lesions and immunohistochemical findings aided in differentiation from metastasis from either a breast carcinoma or a malignant melanoma. Conclusion: in spite of their rarity, keeping the existence of nevus cell aggregates in lymph nodes in mind, that nowadays we examine in an extreme detail, would help us avoid a misdiagnosis of metastasis.

ÖZMeme radyolojisinde temel amaç; lezyonu tespit etmek ve benign ya da malign ayrımına yüksek doğrulukla karar vermektir. Sonoelastografi (SE) incelemesinin son yıllarda ultrason (US) bulgularına ek olarak özgüllüğü artırdığı ifade edilmektedir. Granüler hücreli tümörler memede çok nadir görülür. Mamografide genellikle sınırları belirsiz asimetrik dansite şeklinde görünürken, ultrasonografide yoğun gölge veren, düzen-siz sınırlı kitle(ler) şeklinde izlenir ve malign kitleleri taklit ederler. Olgumuzda kitlenin mamografi ve US özelliklerine ek olarak SE bulgularını da değerlendirdik. Kitlenin elastisite değeri ve oranı malign kitlelerle benzerlik gösterdiğinden SE'nin bu lezyonlarda tanıya ilave katkı sağla-madığı sonucuna vardık.Anahtar kelimeler: Elastografi, sonoelastografi, granüler hücreli tümör ABSTRACTThe main objective of breast imaging is to detect and differentiate benign lesions from malignant ones with higher accuracy rates. Recent studies have reported that sonoelastography (SE) is helpful for distinguishing benign and malignant solid breast masses and shows higher specificity than B-mode ultrasound (US) alone. Granular cell tumors are rare stromal tumors. While mammographically, they appear to be indistinctly marginated asymmetric density, sonographically the lesion generally shows acoustic shadowing and an irregular shape. In our case, in addition to mammography and US findings, we evaluated SE findings as well. The elasticity value and elasticity ratio showed similarity with malignant masses; therefore, we conclude that SE has no additional contribution to diagnosis of these lesions.

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