Cytologic differentiation between proliferative and nonproliferative breast disease in mammographically guided fine‐needle aspirates

Abstract

Fine-needle aspiration biopsy (FNAB) is considered a valid diagnostic procedure in management of patients with breast lesions. It is also important to differentiate benign nonproliferative change from proliferative breast changes, since the risk of development of breast carcinoma in patients with atypical hyperplasia is 4-5 times that of general population. Therefore, the recognition of proliferative breast disease with atypia significantly impacts on the patient's subsequent management. To assess the feasibility of a cytologic grading system to further characterize benign breast lesions, cytologic preparation of 87 mammographically guided FNABs were studied. Cellular aspirates were evaluated for the cellular arrangement, the degree of cellular pleomorphism and anisonucleosis, presence of myoepithelial cells and nucleoli and the status of the chromatin pattern. Values ranging from 1 to 4 were assigned to each cytologic criterion, and a score based on the sum of the individual values was calculated for each case. The minimum score attainable was thus 6. In our chosen criteria cytologic diagnosis of nonproliferative disease was entertained when the total score ranged from 6 to 10. Proliferative disease without atypia was diagnosed with a total score ranging from 11 to 14. Atypical hyperplasia was reported when the total score ranged from 15 to 18. A cytologic diagnosis of malignancy was entertained when the total score ranged from 19 to 24. The cytologic diagnosis was then compared to the reported histologic diagnosis from the excisional biopsies and the data were statistically analysed. A high degree of concordance was found between the cytologic findings and the histologic diagnosis. This study suggests that it is possible to apply a cytologic grading system to further subclassify benign breast disease and distinguish these forms from neoplastic lesions.

Atypia in Random Periareolar Fine-Needle Aspiration Affects the Decision of Women at High Risk to Take Tamoxifen for Breast Cancer Chemoprevention

“…Cytology preparations were also given a semiquantitative index score through evaluation by the Masood cytology index (22-24). As previously described, cells were given a score of 1 to 4 points for each of six morphologic characteristics that include cell arrangement, pleomorphism, number of myoepithelial cells, anisonucleosis, nucleoli, and chromatin clumping; the sum of these points computed the Masood score: V10, nonproliferative (normal); 11 to 12, hyperplasia; 13, high-grade hyperplasia; 14 to 17, atypia; >17, suspicious cytology (13,(22)(23)(24). The number of epithelial cells were quantitated and classified as <10 epithelial cells (insufficient quantity for cytologic analysis), 10 to 100 cells, 100 to 500 cells, 500 to 1,000 cells, 1,000 to 5,000, and >5,000 cells.…”

Fine Needle Aspiration Cytology of the Breast

“…10 In addition, there is overlap in the cytologic features of lesions lacking marked nuclear atypia such as epithelial hyperplasia, atypical hyperplasia, low-grade ductal carcinoma in situ and even invasive carcinoma. 8,17,[22][23][24][25] Finally, specimen adequacy has received controversial definitions. 12,26 In this confusing scenario we found useful the criteria proposed by Wang and Ducatman.…”

Criteria for Reporting Fine Needle Aspiration on Palpable and Nonpalpable Masses of the Breast

“…This cytologic pattern, in the context of either unsuspected or abnormal clinical/mammographic findings, requires follow-up biopsy to rule out carcinoma since the cytologic distinction between atypical ductal hyperplasia, in situ and even invasive ductal carcinoma is often not possible, although it has been attempted by some authors. 1,3,8,17 Atypical Fibroadenoma-Like Tumor (Cannot Rule Out Phyllodes Tumor)…”