Dr. Claire de la Calle

So if you don't see cribriform, it doesn't mean it's not actually there.

But the specificity does seem to be quite high for both large curb reform and introductal carcinoma.

So when I see it, I really believe it.

And we do have several studies that have shown that patients with large curb reform type pattern 4 and introductal carcinoma definitely have much worse oncologic outcomes.

So in my practice, it is an exclusion criteria for active surveillance.

Now, the problem is that there's a lot of discrepancy in how curb reform is reported.

Some pathologists don't report it.

Sometimes small cribriform is reported versus large.

And small cribriform, what is the significance of this on biopsy?

How accurate is it?

Is it as specific as large cribriform?

Personally, I don't think so, although I think we need to do more research on these active surveillance with small cribriform.

So I do have some patients with small cribriform that I monitor.

closely that I do monitor.

But large cribriform and intraductal, I do consider exclusion criteria for active surveillance.

And I do want to mention one more pathologic feature, and that's perineural invasion.

Similar to cribriform, there's a great variability in how it's reported.

Some pathologists don't report it.

There are different definitions of what perineural invasion is.

And