Criteria for the Diagnosis of Fibroepithelial Lesions of the Breast with Liquid-Based Cytology

Ali, Asya; Yin, Diana; Yao, Davis X.; Vazquez, Madeline F.

doi:10.1159/000326408

Cited by 9 publications

(12 citation statements)

References 5 publications

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“…1). Similar features such as the presence of ductal cells in staghorn clusters, isolated myoepithelial cells and stromal fragments have been described in cases of fibroadenomas processed by TP [11,20]. However, different architectural and cell changes have been reported by several studies.…”

Section: ‘Selected' Breast Lesionssupporting

confidence: 61%

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Liquid-Based Cytology in Fine-Needle Aspiration of Breast Lesions: A Review

Gerhard

Schmitt²

2014

Acta Cytologica

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Objective: Fine-needle aspiration (FNA) is a safe and cost-effective technique for the diagnosis of breast lesions, especially when correlated with clinical and imaging studies. However, the success of breast FNA is highly dependent on the adequate preparation of cytological conventional smears (CS). The liquid-based cytology (LBC) technique consists of an automated method for preparing thin-layer cytological samples from cell suspensions collected in alcohol-based preservative. LBC is designed to improve CS by avoiding limiting factors such as obscuring material, air-drying and smearing artifacts. Study Design: We performed a review of the published literature about LBC applied to breast FNA. Results: LBC preparations of breast aspirates demonstrated better cellular preservation, less cell overlapping and elimination of blood and excessive inflammation compared to CS. Conversely, alterations in architecture and cell morphology as well as loss of myoepithelial cells and stromal elements have been described in LBC specimens, requiring training before applying this technique for diagnosis. Studies have shown a similar accuracy between LBC and CS for the diagnosis of breast lesions. LBC also permits the use of residual material for ancillary tests, which is an important advantage compared to CS. Conclusions: LBC can be safely applied to breast FNA, showing a similar diagnostic accuracy to CS.

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Section: ‘Selected' Breast Lesionssupporting

confidence: 61%

“…While staghorn clusters, fibromyxoid stroma and single cells consisting predominantly of myoepithelial cells are characteristic features of a fibroadenoma, the presence of papillary clusters and single columnar cells are findings highly suggestive of a papillary neoplasm [20] (fig. 2).…”

Section: ‘Selected' Breast Lesionsmentioning

confidence: 99%

Liquid-Based Cytology in Fine-Needle Aspiration of Breast Lesions: A Review

Gerhard

Schmitt²

2014

Acta Cytologica

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“…The blind expert review (RA) of the above major discrepancies corrected 5/14 diagnoses (table 3). The borderline phyllodes tumor lacked the characteristic features of such lesions [7,8] but the review by the most LBC-experienced author identified some cell dyshesion and focal background necrosis (histology showed a large infarction). Thus, complete sensitivity and specificity were further increased with a reduction of the false negative rate and of the suspicious rate (table 4).…”

Section: Resultsmentioning

confidence: 99%

“…They may be compounded by LBC because myoepithelial cells may be scanty, monolayer sheets may be fragmented, nucleoli tend to be more prominent and there are more isolated epithelial cells [12,15]. The cytological criteria for the differential diagnosis of the fibroepithelial lesions of the breast, including phyllodes tumors, have been published using LBC and CSm in conjunction [7]. However, cytological-histological correlations and the intra- and interobserver agreement are not perfect [8].…”

Section: Discussionmentioning

confidence: 99%

Liquid-Based Cytology of the Breast: Pitfalls Unrecognized before Specific Liquid-Based Cytology Training - Proposal for a Modification of the Diagnostic Criteria

Feoli

Ameye

Eeckhout³

et al. 2013

Acta Cytologica

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Objectives: To describe the pitfalls encountered in switching over from conventional smears (CSm) to liquid-based cytology (LBC). To explore modifications of our usual diagnostic criteria. Study Design: 190 ThinPrep breast samples with paired biopsies were retrospectively evaluated by two breast cytopathologists experienced only in CSm. They were again studied after LBC training. The diagnostic performances were compared. In additional calculations we included those C4/suspicious samples containing 70% high-grade nuclei and up to 30% nonmalignant cells in the C5/positive category, simulating that they harbored a malignant one-cell population. We prospectively validated this modification of our diagnostic criteria. Results: Training resulted in higher complete sensitivity: 94 versus 86% (p value 0.003) and lower false negative ratio: 4 versus 12% (p value 0.003). Training generated higher complete sensitivity than collaboration without training: 94 versus 89% (p value 0.008). In the simulation, the modified criteria increased absolute sensitivity to 74% with a 0.6% false positive rate. In the validation series, they generated up to 91% absolute sensitivity, 12% suspicious rate and no false negative and false positive diagnoses. Conclusion: Training in breast LBC may increase diagnostic performance. Samples containing 70% high-grade nuclei or more can be categorized as malignant.

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“…Finally, fibroadenomas can be distinguished from papillary neoplasms on ThinPrep FNAC specimens by the presence of antler horn clusters, myxoid stroma, and single myoepithelial cells. Papillary clusters, single ductal epithelial cells (rather than myoepithelial cells) including columnar cells and collagenous spherulosis favor the diagnosis of papillary neoplasia …”

Section: Introductionmentioning

confidence: 99%

Mammary mesenchymal and fibroepithelial lesions: An illustrated cytomorphologic update with differential diagnoses

Khattab

Rowe

Booth

et al. 2019

Diagnostic Cytopathology

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The Uniform Approach to Breast Fine Needle Aspiration Biopsy was put forward by a learned group of breast physicians in 1997. This landmark manuscript focused predominantly on diagnosis and reporting of mammary epithelial lesions. Today, most American practitioners turn initially to core biopsy rather than aspiration biopsy for the first line diagnosis of solid breast lesions; however, recent efforts from the International Academy of Cytology have produced a system called the Standardized Reporting of Breast Fine Needle Aspiration Biopsy Cytology (colloquially labeled in 2017 as the “Yokohama System”), suggesting a new interest in breast fine needle aspiration (FNA), especially in resource limited settings or clinical practice settings with experienced breast cytopathologists. Fibroepithelial lesions of the breast comprise a heterogeneous group of biphasic tumors with epithelial and stromal elements. Mesenchymal lesions of the breast include a variety of neoplasms of fibroblastic, myofibroblastic, endothelial, neural, adipocytic, muscular, and osteo‐cartilaginous derivations. The cytology of mesenchymal breast lesions is infrequently described in the literature and is mainly limited to case reports and small series. This illustrated review highlights the cytologic features of fibroepithelial and mesenchymal mammary proliferations and discusses differential diagnoses and histomorphologic correlates.

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Criteria for the Diagnosis of Fibroepithelial Lesions of the Breast with Liquid-Based Cytology

Cited by 9 publications

References 5 publications

Liquid-Based Cytology in Fine-Needle Aspiration of Breast Lesions: A Review

Liquid-Based Cytology in Fine-Needle Aspiration of Breast Lesions: A Review

Liquid-Based Cytology of the Breast: Pitfalls Unrecognized before Specific Liquid-Based Cytology Training - Proposal for a Modification of the Diagnostic Criteria

Mammary mesenchymal and fibroepithelial lesions: An illustrated cytomorphologic update with differential diagnoses

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