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Fine needle aspiration cytology of the breast: the nonmalignant categories.

Mendoza P, Lacambra M, Tan PH, Tse GM - Patholog Res Int (2011)

Bottom Line: Much has been suggested about the smear adequacy criterion, including quantifying epithelial clusters, whereas others advocate basing adequacy on qualitative quantum of using noncellular features of FNAC.False negativity of FNAC does occur; this could be caused by either "true" false-negative cases attributed to suboptimal sampling technique, poor localization of the mass or nonpalpable lesions or "false" false-negative cases due to interpretational errors.Though false-positive cases are less commonly found, they will also be discussed briefly.

View Article: PubMed Central - PubMed

Affiliation: Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.

ABSTRACT
Currently, accurate diagnosis of breast lesions depends on a triple assessment approach comprising clinical, imaging and pathologic examinations. Fine needle aspiration cytology (FNAC) is widely adopted for the pathologic assessment because of its accurracy and ease of use. While much has been written about the atypical and maliganant categories of FNAC diagnosis, little covers the non-malignanat category which represents a sheer number in all FNAC cases. Moreover, any false-negative diagnosis of the non-malignant cases may lead to missed diagnosis of cancer. This paper aims to discuss the issues of smear adequacy, the cytologic features of benign breast lesions and the dilemma of a false-negative aspirate. Much has been suggested about the smear adequacy criterion, including quantifying epithelial clusters, whereas others advocate basing adequacy on qualitative quantum of using noncellular features of FNAC. Various benign lesions could be easily diagnosed at FNAC; however, they have cytologic features overlapped with malignant lesions. False negativity of FNAC does occur; this could be caused by either "true" false-negative cases attributed to suboptimal sampling technique, poor localization of the mass or nonpalpable lesions or "false" false-negative cases due to interpretational errors. Though false-positive cases are less commonly found, they will also be discussed briefly.

No MeSH data available.


Related in: MedlinePlus

Photomicrograph of hypocellular smear, Pap, 10x. C1, Hypocellular smear.
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fig1: Photomicrograph of hypocellular smear, Pap, 10x. C1, Hypocellular smear.

Mentions: Under this categorization, C1 is inadequate aspirate smear due to hypocellularity, aspiration, smearing or staining errors. Most often, it is the degree of cellularity of the epithelial cells that is inadequate [2] (Figure 1). The exact definition of what constitutes an inadequate aspirate remains an enigma, and this subjective issue is best determined by the interpreter of the aspirate, whether or not a confident diagnosis could be made basing on the quantity of the materials aspirated. C2 category is for smears that are usually cellular, showing the characteristic patterns of different benign lesions. No atypical or malignant features are present. Usually duct configurations, myoepithelial cells, and bipolar nuclei are visible. Inflammatory background is commonly encountered. In contrast, C3 and C4 are the grey zones. C3 presents the characteristics of a benign smear and yet there are features that are not usually seen in clearly benign specimens such as cellular crowding, pleomorphism, and discohesion. C4 is reserved for aspirate where atypical features are obvious but factors such as poor preservation, hypocellularity, or components of a benign smear are present, thus precluding a firm malignant diagnosis to be made. This ambiguity shows the importance of correlation with other disciplines. It also emphasizes not to stretch the result of FNAC beyond the capabilities and experience of the interpreter to reduce both positive and negative errors [2]. C5 category consists of cellular aspirate with evidently malignant cytologic features. As much has been discussed on the atypical, suspicious, and malignant categories, this paper will be limited to the adequate (or inadequate) and benign categories together with the false negative and false positive cases.


Fine needle aspiration cytology of the breast: the nonmalignant categories.

Mendoza P, Lacambra M, Tan PH, Tse GM - Patholog Res Int (2011)

Photomicrograph of hypocellular smear, Pap, 10x. C1, Hypocellular smear.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108472&req=5

fig1: Photomicrograph of hypocellular smear, Pap, 10x. C1, Hypocellular smear.
Mentions: Under this categorization, C1 is inadequate aspirate smear due to hypocellularity, aspiration, smearing or staining errors. Most often, it is the degree of cellularity of the epithelial cells that is inadequate [2] (Figure 1). The exact definition of what constitutes an inadequate aspirate remains an enigma, and this subjective issue is best determined by the interpreter of the aspirate, whether or not a confident diagnosis could be made basing on the quantity of the materials aspirated. C2 category is for smears that are usually cellular, showing the characteristic patterns of different benign lesions. No atypical or malignant features are present. Usually duct configurations, myoepithelial cells, and bipolar nuclei are visible. Inflammatory background is commonly encountered. In contrast, C3 and C4 are the grey zones. C3 presents the characteristics of a benign smear and yet there are features that are not usually seen in clearly benign specimens such as cellular crowding, pleomorphism, and discohesion. C4 is reserved for aspirate where atypical features are obvious but factors such as poor preservation, hypocellularity, or components of a benign smear are present, thus precluding a firm malignant diagnosis to be made. This ambiguity shows the importance of correlation with other disciplines. It also emphasizes not to stretch the result of FNAC beyond the capabilities and experience of the interpreter to reduce both positive and negative errors [2]. C5 category consists of cellular aspirate with evidently malignant cytologic features. As much has been discussed on the atypical, suspicious, and malignant categories, this paper will be limited to the adequate (or inadequate) and benign categories together with the false negative and false positive cases.

Bottom Line: Much has been suggested about the smear adequacy criterion, including quantifying epithelial clusters, whereas others advocate basing adequacy on qualitative quantum of using noncellular features of FNAC.False negativity of FNAC does occur; this could be caused by either "true" false-negative cases attributed to suboptimal sampling technique, poor localization of the mass or nonpalpable lesions or "false" false-negative cases due to interpretational errors.Though false-positive cases are less commonly found, they will also be discussed briefly.

View Article: PubMed Central - PubMed

Affiliation: Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.

ABSTRACT
Currently, accurate diagnosis of breast lesions depends on a triple assessment approach comprising clinical, imaging and pathologic examinations. Fine needle aspiration cytology (FNAC) is widely adopted for the pathologic assessment because of its accurracy and ease of use. While much has been written about the atypical and maliganant categories of FNAC diagnosis, little covers the non-malignanat category which represents a sheer number in all FNAC cases. Moreover, any false-negative diagnosis of the non-malignant cases may lead to missed diagnosis of cancer. This paper aims to discuss the issues of smear adequacy, the cytologic features of benign breast lesions and the dilemma of a false-negative aspirate. Much has been suggested about the smear adequacy criterion, including quantifying epithelial clusters, whereas others advocate basing adequacy on qualitative quantum of using noncellular features of FNAC. Various benign lesions could be easily diagnosed at FNAC; however, they have cytologic features overlapped with malignant lesions. False negativity of FNAC does occur; this could be caused by either "true" false-negative cases attributed to suboptimal sampling technique, poor localization of the mass or nonpalpable lesions or "false" false-negative cases due to interpretational errors. Though false-positive cases are less commonly found, they will also be discussed briefly.

No MeSH data available.


Related in: MedlinePlus