Can nonproliferative breast disease and proliferative breast disease without atypia be Distinguished by fine-needle aspiration cytology?

Abstract

METHODS.Fifty-one air-dried, Diff-Quik-stained fine-needle aspirates (FNA) of palpable breast lesions with biopsy-proven diagnoses of NPBD (34 cases) or PBD 1 Department of Pathology, The George Wash-(17 cases) were reviewed. The smears were evaluated for the cellularity, size, and ington University Medical Center, Washington, architectural arrangement of the epithelial groups; the presence of single epithelial DC.cells and myoepithelial cells; and nuclear characteristics. 2 Department of Surgery, The George Washing- RESULTS.The only cytologic feature found to be significantly different between ton University Medical Center, Washington, DC.PBD and NPBD was a swirling pattern of epithelial cells. A swirling pattern was noted in 13 of 17 PBD cases (76%) and 12 of 34 NPBD cases (35%) (P Å 0.008). CONCLUSIONS. Because there is significant overlap in cytologic features between NPBDand PBD, the distinction between the two entities is difficult in cytologic sampling.

The Role of Fine Needle Aspiration Cytology of the Breast in the Core Biopsy Era

“…However, the decline of FNA cytology is due mainly to a number of limitations of the procedure, including FNA's inability to separate atypical ductal hyperplasia (ADH) from ductal carcinoma in situ (DCIS) and DCIS from invasive carcinoma. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Other limitations include the occasional inability to make a definitive malignant diagnosis when a low-grade carcinoma such as tubular carcinoma or invasive lobular carcinoma is aspirated, as demonstrated in case 1, and the potential for false-positive diagnoses in the aspiration of a number of benign reactive, inflammatory, and metaplastic breast lesions. 5-7,19 -22 Occasionally, it may also be quite challenging in making a specific diagnosis for a variety of fibroepithelial and papillary lesions and differentiating primary from metastatic carcinoma in FNA cytology.…”

Role of fine-needle aspiration cytology in nonpalpable mammary lesions: A comparative cytohistologic study based on 308 cases

“…Also, its microscopic evaluation is not easy, especially in the noncomedonic type, since tumor cells tend to be cohesive, often lack clear-cut evidence of malignancy, and can be confused with gland epitheliosis. 25,26 Two cases originally classed as "probably benign" lesions were a tubular and a lobular carcinoma, respectively. Review of the cytologic slides failed to recognize unequivocal features of malignancy, so a sampling error was regarded as explaining the discrepancy.…”

“…On cytologic grounds, attempts at identifying the complex spectrum of proliferative epithelial changes are even more challenging. 26 Usually, in smears from aytipical ductal hyperplasia, cellularity may be abundant; individual atypical cells scattered in the cellular background may therefore lead to an overdiagnosis of cancer. In our series, the retrospective evaluation of overestimated glandular hyperplasia smears showed threedimensional clusters of atypical cells.…”

The spectrum of cytologic features in nonproliferative breast lesions

“…Studies addressing the issue of distinguishing NPBL from PBL have met with variable success, and the majority of authors acknowledge that a significant cytologic overlap exists in the continuum of proliferative lesions 2, 8, 11, 17. Masood et al9, 10 proposed a cytologic scoring system in which a value of 1–4 was given for each of the following features: cellular arrangement, cellular pleomorphism, presence of myoepithelial cells, anisonucleosis, nucleoli, and chromatin clumping.…”

“…and classified using criteria presented by Page et al1 The 42 cases histologically classified as NPBL by both reviewers were included in the study. These cases are a subset of those included in a previous comparison of NPBL and PBL 2…”