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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 apocrine cells with granular cytoplasm and mild anisonucleosis, Pap, 10x. Apocrine cells: granular cytoplasm and mild anisonucleosis.
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fig3: Photomicrograph of apocrine cells with granular cytoplasm and mild anisonucleosis, Pap, 10x. Apocrine cells: granular cytoplasm and mild anisonucleosis.

Mentions: In more florid examples, thickening of the wall due to papillary apocrine change may cause papillary clusters with the same cytoplasmic and nuclear details to be present [2]. Not all smears from cyst aspirate are easy to evaluate. Apocrine cells, when degenerated will most often appear atypical especially if it has progressed over time to the phase of chromatin clumping with associated anisonucleosis [2], and these could potentially be labeled as suspicious (Figure 3). When there is infection or prior rupture of the cyst, the aspirated fluid may be turbid or milky. Such aspirates often contain degenerated cells and debris in an abundant background of inflammatory cells. In this situation, it needs to be differentiated from the rare squamous carcinoma, which may present with features akin to inflamed cyst.


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

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

Photomicrograph of apocrine cells with granular cytoplasm and mild anisonucleosis, Pap, 10x. Apocrine cells: granular cytoplasm and mild anisonucleosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig3: Photomicrograph of apocrine cells with granular cytoplasm and mild anisonucleosis, Pap, 10x. Apocrine cells: granular cytoplasm and mild anisonucleosis.
Mentions: In more florid examples, thickening of the wall due to papillary apocrine change may cause papillary clusters with the same cytoplasmic and nuclear details to be present [2]. Not all smears from cyst aspirate are easy to evaluate. Apocrine cells, when degenerated will most often appear atypical especially if it has progressed over time to the phase of chromatin clumping with associated anisonucleosis [2], and these could potentially be labeled as suspicious (Figure 3). When there is infection or prior rupture of the cyst, the aspirated fluid may be turbid or milky. Such aspirates often contain degenerated cells and debris in an abundant background of inflammatory cells. In this situation, it needs to be differentiated from the rare squamous carcinoma, which may present with features akin to inflamed cyst.

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