Predictive power of cytomorphological features in equivocal (C3, C4) breast FNAC

Moyes, Colin; Dunne, Barbara

doi:10.1111/j.1365-2303.2004.00157.x

Cited by 8 publications

(11 citation statements)

References 5 publications

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“…Moyes and Dunne [24] tested utility of some cytomorphological criteria for atypical and suspicious cases discrimination. They demonstrated the predictive value, with about 80% specificity, of eccentrically placed epithelial cell nuclei and coarse nuclear chromatin for predicting malignancy.…”

Section: Discussionmentioning

confidence: 99%

HSP27 diagnostic utility in the fine needle aspirate of breast. Correlation with progesterone and estrogen receptors

Młynarczyk-Liszka¹,

Maksymiuk²,

D³

et al. 2009

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Fine needle aspiration (FNA) is routine diagnostic tool in breast tumors assessment. In some cases, however, limitations of this method do not permit an unequivocal diagnosis. In these, suspected, cases immunocytochemical evaluation of selected biological markers may be of help. The aim of the study was assessment of HSP27 value in diagnosis and discrimination of benign and malignant breast lesions. HSP27 expression was examined by immunocytochemistry in fine needle aspiration smears assessed to C2-C5 categories. In C5 subgroup HSP27 expression was correlated with ER, PR content. Statistically significant differences in HSP27 expression between subsets C2/C5 and C3/C5 were found (p=0.028 and p=0,04, respectively); the differences between C3/C4 categories were not significant. Expression of HSP27 protein in FNA smears can be additional factor, which helps to differentiate benign, and malignant breast lesions, however it is not useful for discrimination of cytological, suspicious lesions.

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Section: Discussionmentioning

confidence: 99%

HSP27 diagnostic utility in the fine needle aspirate of breast. Correlation with progesterone and estrogen receptors

Młynarczyk-Liszka¹,

Maksymiuk²,

D³

et al. 2009

neo

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“…Cytological material with >95% cohesion was called predominantly cohesive, whereas smears with >5% of cells presenting as single intact cells were considered discohesive [9,11]. …”

Section: Methodsmentioning

confidence: 99%

“…The cellularity of each sample was quantified as low when there were <10 but >6 clusters observed per sample, as moderate when the number of clusters per sample ranged between 10 and 30 and as many when >30 clusters per sample were seen [11,12]. The predominant size of the cell clusters was recorded as small (3-15 epithelial cells/cluster), medium (16-75 cells/cluster) or large (>75 cells/cluster) [12].…”

Section: Methodsmentioning

confidence: 99%

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The Microscopic Complexities of C3 in Breast Cytology

Weigner

Zardawi²,

Braye³

et al. 2014

Acta Cytologica

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Background: Fine-needle aspiration (FNA) of difficult breast lesions often results in an atypical (C3) report. The assortment of outcomes generated by C3 reports varies widely, and this has given rise to different clinical management pathways. Objective: To identify and objectively assess microscopic features associated with atypical/C3 breast FNA cases. Materials and Methods: A total of 230 atypical breast FNAs were subjected to a blind microscopic rescreen using a range of robust qualitative and quantitative cytological criteria including cellularity, architectural qualities, cytomorphology and background features. A logistic regression with a receiver operating characteristic (ROC) curve and the resultant forward stepwise analysis were conducted to assess the results. This statistical testing was measured against malignant, benign proliferative and benign non-proliferative outcomes. Results: The malignant and benign proliferative outcomes showed a mixture of opposing protective and predictive individual cytological criteria. The stepwise analysis produced models demonstrating the best combination of individual cytological criteria for malignancy, proliferative and benign non-proliferative entities. In the malignancy model, discohesion, nuclear crowding within sheets, diminished numbers of bare bipolar nuclei and myoepithelial cells, the presence of tubules or necrosis and the absence of a cystic background were important features. The benign proliferative model suggested the same criteria but with the opposite implication and with the addition of several others, such as the presence of apocrine metaplasia, retained polarity and a speckled or coarse chromatin pattern. Age was a significant factor in malignant and proliferative outcomes. The benign non-proliferative stepwise analysis produced a model with fewer criteria (complex sheets, bare bipolar nuclei and a cystic background) limiting clinical application. Conclusion: Atypical/C3 breast cytology remains a legitimate reporting category. However, it is associated with a number of different histological outcomes. The incidence of the C3 category can be significantly reduced by controlling extrinsic factors and understanding the associated microscopic features.

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“…C2 and C5 have high predictive values as shown by many studies.The suspicious C4 category is not as certain as C5 but still suggests a high probability of malignancy. The C3 category is an equivocal category commonly used when there is some diagnostic uncertainty regarding the true nature of the lesion (1)(2)(3)(4)(5). There are no standard clinical management strategies for C3 cytology.…”

Section: Introductionmentioning

confidence: 99%

Stratification of risk of malignancy in atypical breast fine needle aspiration: a cytomorphological approach

Weigner

Zardawi²,

Braye

et al. 2017

J Diagnostic Path

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SummaryAlthough atypical (C3) breast cytology is a legitimate reporting category, it is not very useful clinically because it yields benign as well as malignant histological outcomes. Therefore, a cytomorphological approach to minimise inappropriate use of the C3 category may improve the clinical usefulness of this category. In a previous training set of 180 atypical breast cytology (C3) cases we had identified the best discriminating cytological criteria to predict the histological outcomes (malignant, benign proliferative and benign non-proliferative). Using a selection of these previously identified statistically significant criteria (cystic background, cohesiveness, myoepithelial cells or bare bipolar nuclei, papillary fragments and tubules) we tested their ability to predict the same outcomes on 182 subsequent C3 cases (validation set). The diagnostic accuracy for each outcome was compared with the training set. A probability calculator with nominated cut-points was developed to stratify and re-grade C3 cases. Cases outside the cut-points were either up-graded to suspicious (C4) or down-graded to benign (C2). Re-graded cases were reviewed to identify reasons for over or under-interpretation. Statistical analysis showed comparable diagnostic accuracy between the training set and the validation set for malignant and benign proliferative outcomes but not for the benign non-proliferative outcome. The probability calculator resulted in an up-grade of 18% (33/182) ofthe cases. Malignant histology was seen in 25/33 (76%) of the up-graded cases but 8/33 (24%) produced a proliferative non-malignant outcome. A meaningful lower cut-point could not be established without including malignant cases. The C3 category remains a legitimate with a heterogeneous mix of pathological entities. Attempts to minimise inappropriate allocation of C3 cases into this category have met with limited success.

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Predictive power of cytomorphological features in equivocal (C3, C4) breast FNAC

Cited by 8 publications

References 5 publications

HSP27 diagnostic utility in the fine needle aspirate of breast. Correlation with progesterone and estrogen receptors

HSP27 diagnostic utility in the fine needle aspirate of breast. Correlation with progesterone and estrogen receptors

The Microscopic Complexities of C3 in Breast Cytology

Stratification of risk of malignancy in atypical breast fine needle aspiration: a cytomorphological approach

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