Fine‐needle aspiration cytodiagnosis of breast masses in pregnant and lactating women and its impact on management

Gupta, Raj K.; McHutchison, Andrew G. R.; Dowle, Carl S.; Simpson, Judith

doi:10.1002/dc.2840090209

Cited by 51 publications

(18 citation statements)

References 11 publications

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“…FNAC in pregnant and/or lactating women has a higher incidence of FP and FN diagnosis than in nonpregnant/lactating women [29,30,31,32,33]. FP results are due to the fact that the hormonal milieu of pregnancy and lactation leads to epithelial hyperplastic changes with cytologic atypia that can be readily misinterpreted as malignant.…”

Section: Clinical and Cytologic Mimickers Of Malignancymentioning

confidence: 99%

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Indeterminate and Erroneous Fine-Needle Aspirates of Breast with Focus on the ‘True Gray Zone': A Review

2013

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Objective: To review our experience and the literature on inconclusive/erroneous fine-needle aspirates (FNAs) of breast with the focus on the ‘true gray zone'. To describe the cytology, differential diagnosis, pitfalls and limitations of common and rare lesions. Study Design: We conducted a literature search focusing on breast FNAs with statistical data of C3 and C4 categories including false-positive and false-negative cases. Similar data from 2003 to 2009 was obtained from our institution. Results: C3 and C4 categories account for 3-17% of breast FNAs. Contributing factors are technical difficulties, inexperienced pathologists interpreting FNAs of breast and overlap of cytologic features of certain benign and malignant conditions; this last, ‘true gray zone' accounts for 2% of cases. Fibroadenoma, proliferative breast lesions, gynecomastia, infiltrating and in situ low-grade adenocarcinomas and tubular, cribriform, lobular and mucinous carcinomas are the most common problematic lesions. Granular cell tumor, adenomyoepithelioma, pregnancy-related lesions, fat necrosis, inflammatory and radiation changes, adenoid cystic carcinoma, spindle-cell lesions and Phyllodes tumor are less common. Conclusion: Inconclusive/erroneous FNAs of breast due to the ‘true gray zone' are rare. Most are due to the overlapping cytologic features of some benign and malignant conditions. Practical features that may help arrive at the correct diagnoses are elucidated.

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Section: Clinical and Cytologic Mimickers Of Malignancymentioning

confidence: 99%

“…2). As highlighted by Gupta et al [32], a team approach with close clinical correlation and follow-up made FNAC in pregnant women as useful as in nonpregnant women.…”

Section: Clinical and Cytologic Mimickers Of Malignancymentioning

confidence: 99%

Indeterminate and Erroneous Fine-Needle Aspirates of Breast with Focus on the ‘True Gray Zone': A Review

2013

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“…An experienced cytopathologist with specific knowledge of the pregnancy is required to avoid false-positive diagnosis. In this setting, core biopsy represents an effective alternative and is mandatory if malignancy is suspected (21,22).…”

Section: Cytologic Analysismentioning

confidence: 99%

Radiologic Evaluation of Breast Disorders Related to Pregnancy and Lactation

Sabaté

Clotet²,

Torrubia³

et al. 2007

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204

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During pregnancy and lactation, the breast can be affected by a variety of specific and unique disorders, including benign disorders closely related to physiologic changes, inflammatory and infectious diseases, juvenile papillomatosis, and benign and malignant tumors. Patients with pregnancy-associated breast carcinoma tend to have more advanced neoplasms at diagnosis and a poorer prognosis due to delayed diagnosis and a more aggressive biologic pattern. Pregnancy-related Burkitt lymphoma characteristically manifests with bilateral and diffuse involvement of the breasts. Fibroadenoma may manifest with growth, infarction, large cysts, prominent ducts, and secretory hyperplasia during pregnancy and lactation. Galactocele is the breast lesion most commonly found during lactation and manifests as either pseudolipoma, a cystic mass with a fat-fluid level, or pseudohamartoma. Tumors and diseases affecting the breasts during pregnancy and lactation are basically the same as those observed in nonpregnant women but may have a different appearance. The sensitivity of mammography in pregnant and lactating women is decreased due to increased parenchymal density. Instead, ultrasonography is the most appropriate radiologic method for evaluating breast masses in this setting and is particularly useful in the diagnosis and treatment of abscesses. Knowledge of the unique entities that are specifically related to pregnancy and lactation and of their radiologic-pathologic appearances can help the radiologist make the correct diagnosis.

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“…Historically pregnancy-related hyperplastic changes with atypia were thought to result in false-positive FNA results; however, several authors have demonstrated marked accuracy and a reduction in surgical biopsy rates when performed by a skilled pathologist made aware of the patient's pregnant or lactating state [38][39][40][41]. Core needle and excisional biopsy may be employed also.…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

Pregnancy-Associated Breast Cancer: A Literature Review

Barnes

Newman

2007

Surgical Clinics of North America

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Breast cancer, along with cervical cancer, is one of the most commonly diagnosed cancers of pregnancy. Most would define gestational breast cancer as breast cancer that is diagnosed during pregnancy, lactation, and up to 12 months post-partum. The diagnostic and therapeutic implications in this clinical setting are special. These women typically present with a more advanced-stage disease that carries an associated poorer prognosis. Physicians thus are challenged to balance aggressive maternal care with appropriate modifications that will ensure fetal protection. . Of women diagnosed with breast cancer younger than 40 years, only approximately 10% will be pregnant [2,3]. These data certainly suggest a low incidence of pregnancy-associated breast cancer. In fact, historically, the incidence is estimated at 1 in 3000 pregnancies [4][5][6]. Despite the overall low incidence, however, gestational breast cancer is one of the most common pregnancy-associated malignancies, second only to cervical cancer [4,6]. Notably, many have offered that this incidence will only increase as more women delay childbearing until later in life [4,7]. This concern is based on the fact that pregnancy-associated breast cancer is age-related, and women

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Fine‐needle aspiration cytodiagnosis of breast masses in pregnant and lactating women and its impact on management

Cited by 51 publications

References 11 publications

Indeterminate and Erroneous Fine-Needle Aspirates of Breast with Focus on the ‘True Gray Zone': A Review

Indeterminate and Erroneous Fine-Needle Aspirates of Breast with Focus on the ‘True Gray Zone': A Review

Radiologic Evaluation of Breast Disorders Related to Pregnancy and Lactation

Pregnancy-Associated Breast Cancer: A Literature Review

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