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Breast Pathology: Diagnosis by Needle.
  1. I O Ellis

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    PP Rosen. ($165.00.) Lippincott, 1999. ISBN 0 397 58790 2.

    To my knowledge, this is the first comprehensive textbook dealing exclusively with the histological interpretation of needle core biopsy samples. To date, there have been one or two books edited by radiologists on needle core biopsy, which include chapters on histological interpretation. These by their nature have been restricted to basic principles.

    The author of this book is of course well known to pathologists involved in breast disease reporting. He has numerous widely cited publications in peer review and in recent years has produced a major textbook on breast pathology based on his personal experience. Personally, I am a great admirer of his achievement, enthusiasm, and dedication to the field of breast pathology. For this reason, reading this book has been a pleasure.

    First, I would point out that this book although dealing principally with needle core biopsy interpretation is also a distilled version of Rosen's textbook of breast pathology. Diagnostic entities are described in succinct detail and are well referenced.

    The book includes 31 chapters, the first seven dealing with normal anatomy and benign conditions, including one chapter on myoepithelial neoplasms, which form a diagnostic group that appears to be gaining prominence, particularly in the American literature. Rosen recognises that most adenomyoepitheliomas are variants of intraduct papilloma and closely related to ductal adenoma and pleomorphic adenoma.

    There is a substantial chapter on ductal hyperplasia and intraduct carcinoma, which covers in detail the difficulties of distinguishing the microfocal changes present in core biopsy. In this chapter the author recognises that there are some challenging forms of atypical ductal proliferation that exhibit pronounced cytological and architectural atypia, but retain the focal characteristics of usual type hyperplasia, and comments that some pathologists would ignore these latter features and classify the lesions as intraduct carcinoma, whereas others would diagnose atypical hyperplasia. He introduces the concept of the “borderline” lesion. I found this concept useful because it emphasises the fact that a definitive classification of such lesions cannot always be achieved by needle core biopsy, and definitive resection may be required to established the correct diagnosis, be it in situ carcinoma or atypical hyperplasia.

    There are 12 chapters devoted to specific types of breast carcinoma including a chapter on rare special types. Lobular neoplasia, mesenchymal lymphoid, haemopoeitic tumours, and mastitis are dealt with in separate chapters. There is a useful chapter on the pathological effects of radiation and chemotherapy and a short chapter dealing with the pathology associated with needling procedures. This chapter is controversial because it recognises that epithelial displacement can occur as part of the biopsy procedure. Such displaced cells may rest in the stroma or be found as carcinomatous lymphovascular emboli or groups of tumour cells in the subcapsular sinus or lymph node capsule in cases of in situ carcinoma. The clinical relevance of such findings is uncertain and controversial. Dr Rosen sticks his colours to the mast and states that he would regard these as evidence of invasive carcinoma and metastatic carcinoma, respectively.

    The book concludes with three chapters on technical laboratory aspects, image guided techniques for needle core biopsy sampling, and the impact of needle core biopsies on the clinical management of breast disease. These are valuable chapters that I personally feel would have been better placed at the beginning rather than the end of the book. The chapter on pathological examination is succinct but I would give a critical analysis of the coverage of strategies for reporting core biopsies. Although specific diagnostic problems are covered in the various chapters on diagnostic entities, an overview on strategy and handling diagnostic problems, with guidance on reporting and avoidance of pitfalls would have been useful.

    All of the chapters are well illustrated in colour, although the colour balance could have been improved.

    Until relatively recently there has been few textbooks on breast pathology. This position has changed and we have several major textbooks from authorities. Does this book merit purchase for your reporting room? In my view there are two good reasons for considering the purchase of this book. First, the widespread option of needle core biopsy for diagnostic sampling of breast lesions clearly is the door for a textbook, such as this, which considers many of the diagnostic problems that are now being encountered. Second, it serves as an updated and concise version of Rosen's major textbook. Those of you reporting breast disease who have not purchased this textbook could “kill two birds with one stone” by acquiring a copy of this book. I will be placing my copy in our reporting room and suspect that it will spend more of its time open on the bench top rather than gathering dust on our library shelf.

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