Ductal carcinoma‐in‐situ of the breast: Fine‐needle aspiration cytology of 12 cases

Abstract

Aspiration specimens from 12 patients with histologically documented ductal carcinoma-in-situ (DCIS) of the breast (seven patients) or DCIS with minute foci of stromal invasion (five) were evaluated. Five patients presented with palpable masses, 1.5-4.0 cm, and four patients presented with localized thickening, associated with nipple erosion and discharge in two of them. One patient had nipple inversion, and one patient had bilateral nipple discharge. In one patient, no apparent abnormality of the breast was present. Mammography was either suspicious for or strongly suggestive of carcinoma in 10 patients and negative in two. Aspirates from all patients were composed of fragments of atypical ductal epithelium and numerous single epithelial cells. In nine cases, the smears were hypercellular and similar to aspirates of typical invasive ductal carcinoma. Calcifications were present in six cases. In four of these, associated tumor necrosis was evident. Cytologic features separating DCIS patients from those showing minimal stromal invasion or common types of invasive ductal carcinoma (IDC) were not identified. We conclude that fine-needle aspiration cytology of DCIS is identical to that of IDC. If preoperative radiotherapy or chemotherapy is considered in the management of invasive breast carcinoma, cutting-needle biopsy for confirmation of tumor invasion is necessary.

Is a diagnosis of infiltrating versus in Situ ductal carcinoma of the breast possible in fine-needle aspiration specimens?

“…Overall, 48% of DCIS aspirates in our study contained necrosis. As previously reported, 5,14 rare cases of low grade DCIS also can contain necrosis, but findings by one group of investigators contradicted this. 15 However, the majority of reports regarding the cytologic features of DCIS in the literature suffer from limited sample size and the majority of cases being high grade carcinoma with necrosis.…”

“…In our series, 61% of DCIS specimens had scores Ͼ 2ϩ for dissociated single cells, a finding that is in agreement with previous studies that reported no significant difference in the number of dissociated single cells between IDC and DCIS aspirates. 5,11,15 Many single cells also can be observed in atypical ductal hyperplasia and ductal hyperplasia mimicking low grade carcinoma. 6 It has been suggested that the presence of tumor cells infiltrating adipose tissue might be an indication of local stromal invasion.…”

“…5,7,13 Cytomorphologically, high grade DCIS is more likely to have necrosis and single dissociated cells and less likely to have benign epithelial fragments compared with low grade DCIS. Overall, 48% of DCIS aspirates in our study contained necrosis.…”

“…4 Despite prior studies reporting its inability to separate DCIS from IDC, [5][6][7][8] efforts to reevaluate this issue have been made sporadically. 9 -11 To determine whether the diagnosis of stromal invasion can be made based on FNA findings, we studied FNA specimens from 36 breast lesions that had been confirmed histologically as being exclusively DCIS, and we compared the features from these aspirates with those of IDC aspirates.…”

Cytology of “Significant” Breast Ductal Proliferations

“…There are several studies available highlighting the cytologic features employed in evaluating these lesions. 1,4,6,[8][9][10][11] The features stressed include the presence of nuclear overlap; swirling three-dimensional masses with outlying myoepithelial cells and sublumens; small, frayed groups of ductal cells; and alterations in nuclear size and chromatin texture. There is disagreement about whether atypical ductal hyperplasia can be distinguished from ductal carcinoma in situ and the latter from infiltrating carcinoma on fine needle aspiration (FNAC) smears.…”