Fine-needle aspiration cytology of the breast: Invasive vs. in situ carcinoma.

The surgical management of invasive breast carcinoma differs from that of in situ disease. Invasive carcinoma necessitates axillary lymph node dissection, a procedure that has associated morbidity. We studied 80 cases (66 invasive, 14 in situ) of breast carcinoma that had a histological diagnosis and a preoperative fine-needle aspirate. All slides were reviewed, with 17 cytologic features assessed. We found that six of these features showed a statistically significant difference between the invasive and in situ cases. These were infiltration of fat or stroma by malignant cells (72% of invasive cases demonstrated this feature, but it was not present in any of the in situ cases, P = 0.0002), the presence of myoepithelial cells overlying clusters of tumor cells (seen in 86% of in situ tumors and 7% of invasive cases, P < 0.00001), calcification (present in 71% of in situ and 15% of the invasive group, P = 0.001), foamy macrophages (noted in 64% of in situ tumors and 16% of invasive carcinomas, P = 0.0007), intracytoplasmic vacuoles (seen in 50% of invasive cases and 21% of in situ lesions, P = 0.08), and tubules (present in 30% of invasive and 7% of in situ tumors, P = 0.10). We demonstrate that invasion can be suggested in fine-needle aspirates of carcinomas, provided that true infiltration of fibrofatty connective tissue by neoplastic cells is present. In situ disease has characteristic features, but the presence of invasion cannot be excluded, even in the presence of stromal or adipose tissue fragments without tumor infiltration.

A reliable method of demonstrating HER-2/neu, estrogen receptors, and progesterone receptors on routinely processed cytologic material.

Estrogen (ER) and progesterone receptors (PR) and HER-2/neu (c-erbB-2) protein overexpression are important prognostic factors for breast carcinoma. This study describes a simple, rapid method that demonstrates the applicability of these tests to cytology smears. Smears were made from scrape samples of fresh breast tumors and were fixed in 95% alcohol for immunohistochemical staining for ER and PR and HER-2/neu protein overexpression. Scraped material was suspended in phosphate-buffered saline, and cytospin slides were prepared from the suspension and air dried for fluorescence in situ hybridization (FISH). The results for ER performed on cytology compared with the gold standard (immunohistochemistry on histology) showed 94% accuracy (95% confidence bounds (0.8432 0.9823)); PR results showed 71% accuracy (95% confidence bounds (0.5805 0.8180)) and HER-2/neu results showed 77% accuracy (95% confidence bounds (0.6500 0.8709)). Using HER-2/neu gene overamplification detected by FISH as the gold standard, immunohistochemistry for HER-2/neu protein overexpression showed sensitivity, specificity, and a positive predictive value of 88.8%, 77.7%, and 80% for histology, respectively, and 69%, 87%, and 90% for cytology, respectively. This study showed that fixation and storage of smears in 95% alcohol were effective for receptor studies, whereas air-dried cytospin smears were well suited to FISH.

Lipid-rich diffuse malignant mesothelioma: a case report.

An 80-year old man presented with shortness of breath and was found to have a large right pleural effusion. Cytology of the pleural fluid showed atypical papillary clusters of epithelioid cells. Multiple white-yellow nodules studding the pleural surfaces were seen at thoracoscopy, and biopsies showed solid and papillary clusters of large epithelioid cells with abundant cytoplasm filled with clear vacuoles. Special stains and electron microscopic findings indicated that the tumor was a diffuse malignant mesothelioma with numerous intracytoplasmic lipid vacuoles. Fat stain may be useful at time of frozen section for a pleural-based tumor with vacuolated cells, and the presence of lipid vacuoles in a pleural-based tumor does not exclude diffuse malignant mesothelioma.

Cytologic diagnosis and grading of ductal carcinoma in situ.

BACKGROUND: Fine-needle aspiration cytology plays an important role in the preoperative diagnosis of palpable masses as well as impalpable lesions that can only be sampled by stereotactic or ultrasound techniques. A further refinement of cytologic diagnosis would be the ability to distinguish among the different types of ductal carcinoma in situ (DCIS) also between in situ and invasive malignant disease. METHODS: Sixty-six cases of histologically proven, pure DCIS (39 high grade, 12 cribriform, and 15 low/intermediate grade) with a preoperative cytology report of carcinoma were retrieved from our files. All the cytology (wet-fixed and air-dried smears) was reviewed by G.M., and the histology sections were reviewed by G.T. Seven cytologic features, including cellularity, cell dissociation, nuclear size, cell uniformity, nucleoli, nuclear margins, and chromatin pattern, were assigned scores from 1 to 3. The presence of calcium, necrosis, and foamy macrophages was recorded. Cell clusters were examined for evidence of a cribriform pattern. Fat and stromal fragments were closely checked for infiltration by tumor cells. RESULTS: The cell type was predominantly large and pleomorphic in high grade DCIS, whereas it was mainly small and well differentiated in the cribriform and low grade types. Calcium and necrosis were seen in most high grade lesions and less frequently in the cribriform and low grade ones. Macrophages were more common in high grade and cribriform DCIS than in low/intermediate grade DCIS. Cribriform spaces were noted only in cribriform DCIS. Stromal and fat infiltration by tumor cells was not present in any of the aspirates. Myoepithelial cells were rarely seen. CONCLUSIONS: The presence of pleomorphic carcinoma cells, calcium, necrosis, and macrophages in the aspirate accompanied by "casting" calcification on the mammogram is virtually diagnostic of high grade (comedo) DCIS. Cribriform DCIS shows features of low grade carcinoma with a typical cribriform pattern of punched-out holes in the cell clusters. Low/intermediate grade DCIS has no particular distinguishing features. Cancer (Cancer Cytopathol)

The effect of needle gauge and local anaesthetic on the diagnostic accuracy of breast fine-needle aspiration cytology.

AIMS: The value of breast fine needle aspiration cytology (FNAC) is well established. This prospective study evaluates the effects of local anaesthetic (LA) and different gauge needles on the diagnostic accuracy of breast FNAC. METHODS: Aspirates were obtained from 59 consecutive excised breast tumours (51 malignant, eight benign) using green (21-G) and blue-hub (23-G) needles, both before and after infiltration of LA at the aspiration site. RESULTS: There was good agreement for the cytological diagnosis of each tumour when compared by needle size (kappa = 0.85) and the presence of LA (kappa = 0.77). Diagnostic sensitivity ranged from 88 to 92%. None of the differences were statistically significant. In addition LA appeared to have no effect upon the cytological grading of breast carcinomas (chi2 = 1.98, (df 3, P = 0.58). DISCUSSION: The use of the smaller gauge blue-hub needle or LA does not appear to affect adversely the diagnostic accuracy of breast FNAC. Whether using LA or the blue needle routinely in the breast clinic will have an effect upon the discomfort experienced during FNAC remains to be proven.

Heat shock protein (HSP)27: a further refinement in the diagnosis of suspicious fine needle aspirates of breast.

The technique of fine needle aspiration (FNA) is increasingly used in the investigation of breast abnormalities both palpable and impalpable. However, up to 20% of aspirates fall into two categories which require further investigation, because they either show cytological atypia or exhibit features which are suspicious of malignancy (reporting categories C3 and C4). The usefulness of the 27-kD heat shock protein (HSP27) expression in refining these categories of suspicion, and possibly in predicting malignancy, was investigated using an established immunocytochemical staining procedure. Positive HSP27 staining was shown by 73.1% of C4 and 33.3% of C3 FNAs. Statistical analysis showed a significant difference between the results obtained for the C3 and C4 FNAs.

Differential cytologic features of fibroepithelial lesions of the breast.

The surgical treatment of phyllodes tumors differs from that for fibroadenomas, with the former necessitating complete excision with no remaining neoplastic tissue to produce local recurrence. To determine whether we could predict the type of breast lesion on cytology we reviewed the cytological features of 39 fibroepithelial lesions, including ordinary fibroadenomas, fibroadenoma variants (intermediate group), benign phyllodes tumors, and malignant phyllodes tumors, which had a biopsy diagnosis and adequate cytology. We found no differences in the glandular elements, the myoepithelial and single stromal cells, and the type of stromal fragments seen in the three benign groups. The stromal nuclei, the number of leaf-shaped fragments, and the numbers of spindle-cell groups present showed a spectrum of changes varying from those of fibroadenomas at one end to those of benign phyllodes tumors at the other. Malignant phyllodes tumors had characteristic features which were quite different from those of the benign lesions.

Visceral intravascular capillary hemangioma.

In the course of routine pathologic examination of an ovarian serous cystadenoma excised from a 35-year-old woman, an intravascular mass in the cyst capsule was noted. Histologically, this was found to be an intravenous capillary hemangioma. To our knowledge, no such lesion has been previously reported. The relationship of this lesion to intravenous pyogenic granuloma and features by which the two may be distinguished are discussed. Other primary intravascular endothelial tumors are briefly reviewed.