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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 papillary fronds in papilloma, Pap, 10x. Papilloma: papillary fronds.
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fig9: Photomicrograph of papillary fronds in papilloma, Pap, 10x. Papilloma: papillary fronds.

Mentions: Nipple discharge is one of the alarming complaints that would prompt patients to seek clinical consults. This represents, commonly, a papillary lesion involving one of the major lactiferous ducts [2]. Intraductal papillomas are usually solitary and most often found in the subareolar region. It is relatively common, accounting for 2.5% of all benign breast excisions [16]. It is seen as a well-defined mass which radiologically presents as low-density soft tissue mass with no surrounding architectural distortion or tissue response. Calcification, when present, is usually of the dystrophic and curvilinear type [2]. In addition, papillary fronds reminiscent of staghorn clusters can also be seen in papillomas. It was found that foam cells in association with these fronds is one of the more specific features of differentiating papilloma from fibroadenoma [2, 16]. Papillomas in FNAC may cause diagnostic problems. The accuracy of FNAC in diagnosing papillary lesions and differentiating benign and malignant papillary lesions is low [20]. Among the aspirates diagnosed as atypical, intraductal papilloma represents about 6% [21]. For papillomas, the typical FNAC picture of papillary fronds, cell balls, and columnar cells may not all be seen in the aspirate, which may also be complicated by a hemorrhagic background (Figures 9 and 10). At such the cytologic picture may raise the possibility of a malignancy. Problems also occur when the papillomas are complicated by epithelial hyperplasia, hyalinization, or apocrine changes as these may yield hypocellular to hypercellular smears with pleomorphic cells showing prominent and background necrotic debris [22, 23]. To date, there have been no well-defined cytological criteria to differentiate between benign and malignant papillary lesions. Their significant overlap in terms of architecture and cytological atypia is the primary reasons for not differentiating them cytologically [20, 21].


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

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

Photomicrograph of papillary fronds in papilloma, Pap, 10x. Papilloma: papillary fronds.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig9: Photomicrograph of papillary fronds in papilloma, Pap, 10x. Papilloma: papillary fronds.
Mentions: Nipple discharge is one of the alarming complaints that would prompt patients to seek clinical consults. This represents, commonly, a papillary lesion involving one of the major lactiferous ducts [2]. Intraductal papillomas are usually solitary and most often found in the subareolar region. It is relatively common, accounting for 2.5% of all benign breast excisions [16]. It is seen as a well-defined mass which radiologically presents as low-density soft tissue mass with no surrounding architectural distortion or tissue response. Calcification, when present, is usually of the dystrophic and curvilinear type [2]. In addition, papillary fronds reminiscent of staghorn clusters can also be seen in papillomas. It was found that foam cells in association with these fronds is one of the more specific features of differentiating papilloma from fibroadenoma [2, 16]. Papillomas in FNAC may cause diagnostic problems. The accuracy of FNAC in diagnosing papillary lesions and differentiating benign and malignant papillary lesions is low [20]. Among the aspirates diagnosed as atypical, intraductal papilloma represents about 6% [21]. For papillomas, the typical FNAC picture of papillary fronds, cell balls, and columnar cells may not all be seen in the aspirate, which may also be complicated by a hemorrhagic background (Figures 9 and 10). At such the cytologic picture may raise the possibility of a malignancy. Problems also occur when the papillomas are complicated by epithelial hyperplasia, hyalinization, or apocrine changes as these may yield hypocellular to hypercellular smears with pleomorphic cells showing prominent and background necrotic debris [22, 23]. To date, there have been no well-defined cytological criteria to differentiate between benign and malignant papillary lesions. Their significant overlap in terms of architecture and cytological atypia is the primary reasons for not differentiating them cytologically [20, 21].

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