The Cytopathology of Proliferative Breast Disease:Comparison With Features of Ductal Carcinoma In Situ

Abstract

Epithelial hyperplasia, a component of proliferative breast disease (PBD), is a known risk factor for the development of breast carcinoma. To determine if criteria established for tissue biopsy could be used to more precisely define cytologic criteria for diagnosis of PBD, 37 breast fine-needle aspirates with biopsy diagnoses of PBD were studied. In cases with adequate cellularity, the following findings were consistently observed: (1) three-dimensional cell clusters with outlying myoepithelial cells, swirling intralumenal masses and peripheral, slit-like, irregular sublumens (65% of cases); (2) convoluted sheets of ductal epithelium with outlying myoepithelial cells and bulbous projections tethered to the ductal lining (29%); and (3) a background of discohesive small frayed groups of ductal cells (32%). Of the 15 cases that did not meet these criteria, most were paucicellular (87%), which suggested sampling error. Other cytologic features that were observed included: moderately increased cellularity (20 cases), moderate-to-marked nuclear overlap (14 cases), minimal nuclear atypia, and few single epithelial cells. Fifteen cases of confirmed ductal carcinoma in situ were studied for comparison. In these cases, cellularity, nuclear overlap, and atypia were increased, but swirling intralumenal masses, prominent myoepithelial cells and slit-like lumens were absent. In conclusion, the features of PBD established for tissue biopsy can be applied to cytologic specimens, and may provide useful clues to the diagnosis of epithelial hyperplasia in breast fine-needle aspiration specimens.

Evaluation of scoring system in cytological diagnosis and management of breast lesion with review of literature

“…The scoring systems proposed by Page et al [11] and Dawson AE et al [6] have consistently found that architectural features like three-dimensional epithelial clusters, swirling or streaming of intraluminal cells and peripheral slit-like irregular lumen helped to differentiate PBD without atypia from ductal carcinoma insitu (DCIS), the findings which were supported by Sneige and Staerkel. [12] Most studies for scoring of breast lesions use traditional cytologic features that include cellularity, nuclear pleomorphism, overlap and loss of polarity.…”

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)…”

Evaluation of Masood’s and Modified Masood’s Scoring Systems in the Cytological Diagnosis of Palpable Breast Lump Aspirates

“…Many authors have used various means to come to a conclusive method of diagnosis by FNAC of breast lesions [8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”