Archives of pathology & laboratory medicine最新文献

{"title":"Effects of the Paris System on the Unsatisfactory Category in a Cytohistologic Correlation Study of Patients With Urothelial Carcinoma.","authors":"Karina Munhoz de Paula Alves Coelho, Hercilio Fronza, Paula de Carvalho, Giordano Barzotto Tagliari, Lara Cristina Carvalho de Tavares, Jaqueline Stall, Hortência Gomes da Silveira, Paulo Henrique Condeixa de França","doi":"10.5858/arpa.2023-0506-OA","DOIUrl":"10.5858/arpa.2023-0506-OA","url":null,"abstract":"<p><strong>Context.—: </strong>The main objectives of the Paris System are to detect high-grade urothelial carcinoma, to standardize morphologic criteria and the cytopathologic report, to reduce the prevalence of the atypia category, and to improve the malignancy risk stratification.</p><p><strong>Objective.—: </strong>To compare the results and sensitivity of cytologic classification before and after reclassification by the Paris System.</p><p><strong>Design.—: </strong>Urinary cytology samples from patients with a histologic diagnosis of urothelial carcinoma were reclassified on the basis of the Paris System categories. The diagnoses before reclassification were divided into 5 categories (A, B, C, D, E) and compared with the Paris System (I, II, III, IV, V). Sensitivity was calculated considering cytohistologic agreement in relation to high-grade urothelial carcinoma.</p><p><strong>Results.—: </strong>A total of 111 urinary cytology samples from patients were analyzed, corresponding to 40 histologic samples; of these, 12 (30%) were high grade and the remaining were low grade. Comparison of the correlated categories showed an increase from 3 (3 of 111; 2.7%) (A) to 31 (31 of 111; 27.9%) (I) in unsatisfactory cases and a decrease from 67 (67 of 111; 60.0%) to 30 (30 of 111; 27.0%) in negative cases, while the atypia category remained unchanged (15 cases [15 of 111; 13.5%]) (C and III). Suspicious cases increased from 5 (5 of 111; 4.5%) (D) to 14 (14 of 111; 12.6%) (IV) and cases of urothelial carcinoma were unchanged (21 cases [21 of 111; 18.9%]) (E and V). Sensitivity was 69% for the previous classification and 90% for the Paris System.</p><p><strong>Conclusions.—: </strong>The Paris System improved the sensitivity of urinary cytology and the standardization of the unsatisfactory criteria, with an increase of cases in this category and a decrease of cases previously classified as negative among patients with a subsequent histologic diagnosis of urothelial carcinoma.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"368-371"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Human Leukocyte Antigen Testing Technologies and Management Strategies for Platelet Transfusion Refractoriness.","authors":"H Cliff Sullivan, P Dayand Borge, Richard R Gammon, Manish Gandhi, Mary C Philogene, YanYun Wu, Patricia M Kopko","doi":"10.5858/arpa.2023-0484-RA","DOIUrl":"10.5858/arpa.2023-0484-RA","url":null,"abstract":"<p><strong>Context.—: </strong>The blood bank is often consulted for transfusion support of patients with suspected platelet transfusion refractoriness (PTR). The workup is complex because testing includes specialized assays that are uncommonly ordered with limited availability. Add to this the variety of possible products-crossmatched platelets, human leukocyte antigen (HLA)-matched platelets, HLA antigen-negative platelets-and the approach to PTR can be overwhelming. Moreover, most literature on the subject is published in transfusion medicine journals aimed at transfusion medicine physicians and blood bank specialists in academic settings. Resources tailored to community hospital blood banks are lacking.</p><p><strong>Objective.—: </strong>To provide pathologists who may not have subspecialized training in transfusion medicine and who direct blood bank algorithmic workflows based on clinical scenario and test availability to provide appropriate transfusion support for patients with PTR.</p><p><strong>Data sources.—: </strong>This review is a comprehensive overview of terminology, HLA testing procedures, interpretations, and practical recommendations for managing PTR in various scenarios based on expert opinion as well as relevant medical literature published from 2007 to 2022.</p><p><strong>Conclusions.—: </strong>Consultation on PTR is complicated and encompasses many clinical and laboratory aspects. The lack of guidelines derived from high-quality prospective studies poses challenges in the workup and management of PTR. Hindering the process further are limited test availability, unfamiliarity with the technical assays, and the various specialized platelet products. The clinical evaluation algorithm presented herein along with the workflow pathways offer pathologists user-friendly and best-practice guidelines with different options based on the clinical scenario and the tests available.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"372-380"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant Chemotherapy Response in Triple-Negative Apocrine Carcinoma: Comparing Apocrine Morphology, Androgen Receptor, and Immune Phenotypes.","authors":"Inwoo Hwang, Yoojoo Lim, Sanghoon Song, Hyunwoo Lee, Yoon Ah Cho, Young-Hyuck Im, Jin Seok An, Yeon Hee Park, Ji-Yeon Kim, Eun Yoon Cho","doi":"10.5858/arpa.2023-0561-OA","DOIUrl":"10.5858/arpa.2023-0561-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Apocrine differentiation and androgen receptor (AR) positivity represent a specific subset of triple-negative breast cancer (TNBC) and are often considered potential prognostic or predictive factors.</p><p><strong>Objective.—: </strong>To evaluate the response of TNBC to neoadjuvant chemotherapy (NAC) and to assess the impact of apocrine morphology, AR status, Ki-67 labeling index (Ki-67LI), and tumor-infiltrating lymphocytes (TILs).</p><p><strong>Design.—: </strong>A total of 232 TNBC patients who underwent NAC followed by surgical resection in a single institute were analyzed. The study evaluated apocrine morphology and AR and Ki-67LI expression via immunohistochemistry from pre-NAC biopsy samples. Additionally, pre-NAC intratumoral TILs and stromal TILs (sTILs) were quantified from biopsies using a deep learning model. The response to NAC after surgery was assessed based on residual cancer burden.</p><p><strong>Results.—: </strong>Both apocrine morphology and high AR expression correlated with lower Ki-67LI (P < .001 for both). Apocrine morphology was associated with lower postoperative pathologic complete response (pCR) rates after NAC (P = .02), but the difference in TILs between TNBC cases with and without apocrine morphology was not statistically significant (P = .09 for sTILs). In contrast, AR expression did not significantly affect pCR (P = .13). Pre-NAC TILs strongly correlated with postoperative pCR in TNBCs without apocrine morphology (P < .001 for sTILs), whereas TNBC with apocrine morphology demonstrated an indeterminate trend (P = .82 for sTILs).</p><p><strong>Conclusions.—: </strong>Although TIL counts did not vary significantly based on apocrine morphology, apocrine morphology itself was a more reliable predictor of NAC response than AR expression. Consequently, although apocrine morphology is a rare subtype of TNBC, its identification is clinically important.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"354-362"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generative Artificial Intelligence in Anatomic Pathology.","authors":"Victor Brodsky, Ehsan Ullah, Andrey Bychkov, Andrew H Song, Eric E Walk, Peter Louis, Ghulam Rasool, Rajendra S Singh, Faisal Mahmood, Marilyn M Bui, Anil V Parwani","doi":"10.5858/arpa.2024-0215-RA","DOIUrl":"10.5858/arpa.2024-0215-RA","url":null,"abstract":"<p><strong>Context.—: </strong>Generative artificial intelligence (AI) has emerged as a transformative force in various fields, including anatomic pathology, where it offers the potential to significantly enhance diagnostic accuracy, workflow efficiency, and research capabilities.</p><p><strong>Objective.—: </strong>To explore the applications, benefits, and challenges of generative AI in anatomic pathology, with a focus on its impact on diagnostic processes, workflow efficiency, education, and research.</p><p><strong>Data sources.—: </strong>A comprehensive review of current literature and recent advancements in the application of generative AI within anatomic pathology, categorized into unimodal and multimodal applications, and evaluated for clinical utility, ethical considerations, and future potential.</p><p><strong>Conclusions.—: </strong>Generative AI demonstrates significant promise in various domains of anatomic pathology, including diagnostic accuracy enhanced through AI-driven image analysis, virtual staining, and synthetic data generation; workflow efficiency, with potential for improvement by automating routine tasks, quality control, and reflex testing; education and research, facilitated by AI-generated educational content, synthetic histology images, and advanced data analysis methods; and clinical integration, with preliminary surveys indicating cautious optimism for nondiagnostic AI tasks and growing engagement in academic settings. Ethical and practical challenges require rigorous validation, prompt engineering, federated learning, and synthetic data generation to help ensure trustworthy, reliable, and unbiased AI applications. Generative AI can potentially revolutionize anatomic pathology, enhancing diagnostic accuracy, improving workflow efficiency, and advancing education and research. Successful integration into clinical practice will require continued interdisciplinary collaboration, careful validation, and adherence to ethical standards to ensure the benefits of AI are realized while maintaining the highest standards of patient care.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"298-318"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Breast Pathology Reporting Needs and Development of Tumor Synoptic Templates in Sub-Saharan Africa.","authors":"Gilbert Z Nkya, Oluwatosin Zainab Omoyiola, Omolade Adefolabi Betiku, Dianna L Ng, Fabiola Couto Fernandes, Neybi Stella Tacula, Carla Carrilho, Angela Elisha Pallangyo, Omolade O Adegoke, Jamie L Gilliland, Alex Richard Mremi, Marcia Edelweiss","doi":"10.5858/arpa.2024-0101-OA","DOIUrl":"10.5858/arpa.2024-0101-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Breast pathology reports include many important details to guide clinical management. Reports with missing critical data elements are commonly seen in non-subspecialized pathology practices. The use of synoptic templates has been shown to improve pathology reports. Although synoptic templates are readily available from professional societies, many are not tailored to low-resource settings.</p><p><strong>Objective.—: </strong>To perform an assessment of current breast pathology reporting at 3 referral hospitals in sub-Saharan Africa and design a locally adapted breast cancer synoptic template.</p><p><strong>Design.—: </strong>We conducted semi-structured interviews with key stakeholders involved in breast cancer care, including pathologists, radiologists, oncologists, and surgeons, from Nigeria, Tanzania, and Mozambique. Moreover, each stakeholder reviewed a preliminary synoptic template that was compiled by using templates from the College of American Pathologists, Royal College of Pathologists, and International Collaboration on Cancer Reporting and was asked to score each data element as essential, optional, or exclude. A locally adapted synoptic template was then designed from the needs assessment. Using the adapted templates, a retrospective review of breast cancer pathology reports from 2020 to 2022 was conducted to determine the completeness of reports at the 3 institutions.</p><p><strong>Results.—: </strong>A total of 17 physicians were interviewed. Review of pathology reports revealed that none of the reports across all 3 sites contained all data elements considered essential by local physicians.</p><p><strong>Conclusions.—: </strong>There is an urgent need to improve breast pathology reporting in sub-Saharan Africa. Development and implementation of synoptic templates in collaboration with key stakeholders has the potential to improve pathology reporting practices in low-resource settings.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"340-346"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance Characteristics of Incisional and Core Needle Biopsies for Diagnosis in Parotid Gland: Single-Institutional Experience and Assessment of the Value of a Milan System for Reporting Salivary Gland Cytopathology-Like Risk Stratification Model.","authors":"Rayan Rammal, Qian Wang, N Paul Ohori, Mark Kubik, Simion I Chiosea, Raja R Seethala","doi":"10.5858/arpa.2024-0051-OA","DOIUrl":"10.5858/arpa.2024-0051-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Unlike parotid fine-needle aspiration biopsy, standardized reporting for core needle biopsy (CNB) and incisional biopsy (IB) is not established.</p><p><strong>Objective.—: </strong>To examine the value of risk stratification by a Milan System for Reporting Salivary Gland Cytopathology (MSRSGC)-like classifier for parotid CNB/IB.</p><p><strong>Design.—: </strong>Five hundred ninety-two parotid biopsy records (CNB = 356, IB = 236) were retrieved (1994-2022) along with clinicopathologic data. Diagnoses were transformed to an MSRSGC-like classifier and compared with end points including risk of malignancy.</p><p><strong>Results.—: </strong>Over time, CNB was progressively more used compared with IB. Overall malignancy call rate was 223 of 592 (37.7%). Common specific diagnoses included Warthin tumor, lymphoma subtypes, and metastatic squamous cell carcinoma for CNB and IB, in addition to pleomorphic adenoma for CNB. Descriptive diagnoses were still frequent. Nondiagnostic rates were higher in CNB (26 of 356; 7.30%) than IB (5 of 236; 2.12%; P < .001). Tissue volumes significantly influenced CNB adequacy, with minimum and optimal volumes of 4.76 mm³ (J index, receiver operating characteristic curve) and 12.92 mm³ (95th percentile of distribution), respectively. One hundred forty-four patients (112 CNBs) had follow-up resections; diagnoses were concordant for 66 of 73 adequate CNBs (90.41%). Our restructured risk grouping of MSRSGC categories performed robustly in terms of risk of malignancy (sensitivity = 85.5%, specificity = 100%, accuracy = 92.3%, area under the curve = 0.9677).</p><p><strong>Conclusions.—: </strong>Although CNB and IB are amenable to a risk stratification system, there are some differences as compared with fine-needle aspiration biopsy, particularly given the high baseline prevalence of malignancy. Specific diagnoses are often feasible and concordant with resection. CNB tissue volume can inform optimal and minimal sampling recommendations for adequacy.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"328-339"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Adenocarcinoma Updates: Histology, Cytology, and Grading.","authors":"Jake Sharma, Fang Zhou, Andre L Moreira","doi":"10.5858/arpa.2023-0540-RA","DOIUrl":"10.5858/arpa.2023-0540-RA","url":null,"abstract":"<p><strong>Context.—: </strong>Adenocarcinomas are the most common histologic subtype of lung cancer, and exist within a widely divergent clinical, radiologic, molecular, and histologic spectrum. There is a strong association between histologic patterns and prognosis that served as the basis for a recently described grading system. As the study of molecular pathology rapidly evolves, all targetable mutations so far have been found in adenocarcinomas, thus requiring accurate diagnosis and classification for the triage of molecular alterations and adequate therapy.</p><p><strong>Objective.—: </strong>To discuss the rationale for adenocarcinoma classifications within the 2021 5th edition of the World Health Organization Classification, with a focus on nonmucinous tumors, including tumor grading and biopsy/cytology diagnosis.</p><p><strong>Data sources.—: </strong>PubMed search.</p><p><strong>Conclusions.—: </strong>A grading system for adenocarcinoma has improved prognostic impact of the classification of pulmonary adenocarcinoma. An accurate diagnosis of adenocarcinoma in small biopsy material is important for tissue triage for molecular studies and ultimately for patient management and treatment.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"e82-e86"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General Applicability of Existing College of American Pathologists Accreditation Requirements to Clinical Implementation of Machine Learning-Based Methods in Molecular Oncology Testing.","authors":"Larissa V Furtado, Kenji Ikemura, Cagla Y Benkli, Joel T Moncur, Richard S P Huang, Ahmet Zehir, Katherine Stellato, Patricia Vasalos, Navid Sadri, Carlos J Suarez","doi":"10.5858/arpa.2024-0037-CP","DOIUrl":"10.5858/arpa.2024-0037-CP","url":null,"abstract":"<p><strong>Context.—: </strong>The College of American Pathologists (CAP) accreditation requirements for clinical laboratory testing help ensure laboratories implement and maintain systems and processes that are associated with quality. Machine learning (ML)-based models share some features of conventional laboratory testing methods. Accreditation requirements that specifically address clinical laboratories' use of ML remain in the early stages of development.</p><p><strong>Objective.—: </strong>To identify relevant CAP accreditation requirements that may be applied to the clinical adoption of ML-based molecular oncology assays, and to provide examples of current and emerging ML applications in molecular oncology testing.</p><p><strong>Design.—: </strong>CAP accreditation checklists related to molecular pathology and general laboratory practices (Molecular Pathology, All Common and Laboratory General) were reviewed. Examples of checklist requirements that are generally applicable to validation, revalidation, quality management, infrastructure, and analytical procedures of ML-based molecular oncology assays were summarized. Instances of ML use in molecular oncology testing were assessed from literature review.</p><p><strong>Results.—: </strong>Components of the general CAP accreditation framework that exist for traditional molecular oncology assay validation and maintenance are also relevant for implementing ML-based tests in a clinical laboratory. Current and emerging applications of ML in molecular oncology testing include DNA methylation profiling for central nervous system tumor classification, variant calling, microsatellite instability testing, mutational signature analysis, and variant prediction from histopathology images.</p><p><strong>Conclusions.—: </strong>Currently, much of the ML activity in molecular oncology is within early clinical implementation. Despite specific considerations that apply to the adoption of ML-based methods, existing CAP requirements can serve as general guidelines for the clinical implementation of ML-based assays in molecular oncology testing.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"319-327"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the 2022 International Consensus and World Health Organization Classifications of Hematopathology: A Call for Unified Diagnostic Language.","authors":"Hadil Zureigat, Bridget Adcock, Daniel P Nurse, Asad Rauf, Heya Batah, Mariah Ondeck, Bianca Honnekeri, MaryBeth Mercer, Xuefei Jia, Matthew Rump, Kamran M Mirza, Samer Al Hadidi, Moaath K Mustafa Ali","doi":"10.5858/arpa.2024-0031-OA","DOIUrl":"10.5858/arpa.2024-0031-OA","url":null,"abstract":"<p><strong>Context.—: </strong>In 2022, 2 distinct guidelines for the diagnosis of myeloid neoplasms became available: the 5th edition of the World Health Organization guideline (WHO2022) solely and the International Consensus Classification (ICC). Despite major overlap, there are important differences that can have important implications.</p><p><strong>Objective.—: </strong>To explore the current opinions and diagnostic practices of hemato-oncologists and hematopathologists across the United States.</p><p><strong>Design.—: </strong>An online anonymous survey was created using REDCap, and a secure link was shared via email to fellowship program leadership and via posts on social media.</p><p><strong>Results.—: </strong>A total of 310 responses were obtained. Only 33 of 309 respondents (10.7%) reported using solely the 2016 World Health Organization guideline to make diagnoses, whereas 167 of 309 (54%) supplemented it with other guidelines. The rest were either not sure (17; 5.5%), used WHO2022 solely (46; 14.9%), or used ICC solely (6; 1.9%). The choice of guideline was not related to region (P = .15), practice setting (P = .86), or hospital size (P = .22). More than 90% reported having 2 distinct guidelines is a source of confusion in clinical diagnosis, management, trial design, and other areas.</p><p><strong>Conclusions.—: </strong>Overall, our study found that having 2 distinct guidelines could be a source of confusion for physicians and it highlights the need for a unified diagnostic language.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"363-367"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pathologic Spectrum of Pregnancy and Lactation-Associated Breast Lesions.","authors":"Namra Ajmal, Lucy X Ma, Juan P Palazzo","doi":"10.5858/arpa.2024-0461-RA","DOIUrl":"https://doi.org/10.5858/arpa.2024-0461-RA","url":null,"abstract":"<p><strong>Context.—: </strong>Lactational lesions of the breast encompass a wide range of entities, ranging from physiologic changes to aggressive malignant tumors. Topics discussed under this umbrella include lactational change, galactocele, mastitis (acute and non-lactational), lactational adenoma, and pregnancy and lactation-associated breast carcinoma. Although the literature suggests that the histopathology of atypia and carcinoma in this context is similar to that in patients of comparable age without associated pregnancy or lactation, diagnosing these on core needle biopsies may be difficult, particularly in the presence of concurrent mastitis.</p><p><strong>Objective.—: </strong>To review the clinical, radiologic, and specific histopathologic features of lactational lesions of the breast, their differential diagnoses, and challenging aspects as frequently encountered on core needle biopsies.</p><p><strong>Data sources.—: </strong>The existing scientific and clinical literature from PubMed search as of August 2024 is the primary source of the review. Select cases of pregnancy and lactation-associated lesions from the Thomas Jefferson Hospital breast pathology archives are included and discussed in this review.</p><p><strong>Conclusions.—: </strong>Accurate diagnosis of pregnant and lactating patients with breast lesions requires clinical, radiologic, and histopathologic correlation. Careful examination of biopsy cores and maintaining a high index of suspicion, even without clear radiologic findings, are essential for identifying atypia. When significant acute mastitis and overlapping secretory/lactational changes complicate the characterization of atypia, requesting additional tissue, using appropriate immunohistochemical stains, or deferring to excisional biopsy is appropriate. Awareness of these entities, given their varied prognoses and the sociopsychological challenges of postpartum and lactation, is crucial for guiding effective management.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}