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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 cyst contents composed of scattered macrophages and clusters of benign ductal cells, Pap, 4x. Cyst contents: scattered macrophages and few clusters of benign ductal cells.
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fig2: Photomicrograph of cyst contents composed of scattered macrophages and clusters of benign ductal cells, Pap, 4x. Cyst contents: scattered macrophages and few clusters of benign ductal cells.

Mentions: The bulk of breast FNAC diagnoses are benign, accounting for 24–77.5% of cases (Table 3). Fibrocystic changes present a spectrum of histological features that may sometimes be associated with calcification. Cystic changes represent a common finding. Characteristically, the size of the cyst varies in between consultation visits, giving the clinician further hint on its benign nature, especially when accompanied by imaging studies. In most situations, the aspirated cyst fluid may not be routinely submitted for cytologic evaluation, except when the fluid is blood stained, cloudy, or turbid or when the masses remain uncollapsed and palpable after the aspiration. Most of the time, the smears would only show macrophages mixed with other inflammatory cells, confirming the cystic content nature of the lesion. Ductal epithelial and myoepithelial cells are also commonly seen in cyst aspirate, mostly as small balls and clusters mixed with the macrophages (Figure 2). Apocrine cells lining cyst cavity may exfoliate, showing the characteristic eosinophilic cytoplasm and round nuclei with distinct nucleoli. The above findings of apocrine cells, macrophages, and ductal cells are the characteristic features of a nonproliferative type of fibrocystic changes, which yields only scanty materials. When there is a significant epithelial proliferative component, sheets and tight clusters of cells are usually prominent. The presence of atypia in these cellular clusters may be further evaluated basing on cellular and nuclear spacing, multiple nucleoli, and character of chromatin materials. When these cytologic features are encountered, intraductal papilloma and fibroadenoma are some of the differentials that need to be ruled out. Though cytologically indistinguishable from proliferative fibrocystic changes, intraductal papilloma is often accompanied by clinical history of nipple discharge and a palpable subareolar mass.


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

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

Photomicrograph of cyst contents composed of scattered macrophages and clusters of benign ductal cells, Pap, 4x. Cyst contents: scattered macrophages and few clusters of benign ductal cells.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig2: Photomicrograph of cyst contents composed of scattered macrophages and clusters of benign ductal cells, Pap, 4x. Cyst contents: scattered macrophages and few clusters of benign ductal cells.
Mentions: The bulk of breast FNAC diagnoses are benign, accounting for 24–77.5% of cases (Table 3). Fibrocystic changes present a spectrum of histological features that may sometimes be associated with calcification. Cystic changes represent a common finding. Characteristically, the size of the cyst varies in between consultation visits, giving the clinician further hint on its benign nature, especially when accompanied by imaging studies. In most situations, the aspirated cyst fluid may not be routinely submitted for cytologic evaluation, except when the fluid is blood stained, cloudy, or turbid or when the masses remain uncollapsed and palpable after the aspiration. Most of the time, the smears would only show macrophages mixed with other inflammatory cells, confirming the cystic content nature of the lesion. Ductal epithelial and myoepithelial cells are also commonly seen in cyst aspirate, mostly as small balls and clusters mixed with the macrophages (Figure 2). Apocrine cells lining cyst cavity may exfoliate, showing the characteristic eosinophilic cytoplasm and round nuclei with distinct nucleoli. The above findings of apocrine cells, macrophages, and ductal cells are the characteristic features of a nonproliferative type of fibrocystic changes, which yields only scanty materials. When there is a significant epithelial proliferative component, sheets and tight clusters of cells are usually prominent. The presence of atypia in these cellular clusters may be further evaluated basing on cellular and nuclear spacing, multiple nucleoli, and character of chromatin materials. When these cytologic features are encountered, intraductal papilloma and fibroadenoma are some of the differentials that need to be ruled out. Though cytologically indistinguishable from proliferative fibrocystic changes, intraductal papilloma is often accompanied by clinical history of nipple discharge and a palpable subareolar mass.

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