Cytological Criteria for Predicting the Luminal Phenotype of Breast Carcinoma.

BACKGROUND: Specific cytological criteria for the luminal phenotype of breast carcinoma, despite it being the most common and having a better prognosis as well as targeted therapies under study, remain to be established. Using fine-needle aspiration cytology (FNAC), we aimed to identify the luminal phenotype through the evaluation of cytological criteria recognized in routine practice. METHODS: We correlated 169 FNACs of breast carcinomas with their tissue specimens, classified into phenotypes by immunohistochemistry (applying tissue microarray technology) as luminal A, luminal B, HER2 overexpression, and triple negative. All FNAC samples were blindly reviewed according to cellularity, cell cohesion, necrosis, nucleoli, and nuclear atypia. Fisher's exact test was used to test associations between the cytological criteria and phenotypes. RESULTS: The following phenotypes were obtained - luminal A: 107 (63.3%), luminal B: 39 (23.1%), HER2 overexpression: 8 (4.7%), and triple negative: 15 (8.9%). The luminal phenotype showed mild/moderate cellularity (40.4%) (OR = 7.12, 95% CI: 1.61-31.52), inconspicuous, present nucleoli (55.5%) (OR = 8.31, 95% CI: 2.36-29.19), and mild/moderate nuclear atypia (44.5%) (OR = 8.42, 95% CI: 1.90-37.25). CONCLUSION: The criteria that might indicate the luminal phenotype of breast carcinoma in FNAC were mild/moderate cellularity, inconspicuous, present, and nonprominent nucleoli, and mild/moderate nuclear atypia.

Comparação de resultados obstétricos e neonatais entre primíparas e multíparas assistidas no domicílio / Comparison of obstetric and neonatal outcomes between primiparous and multiparous assisted at home / Comparación de los resultados obstétricos y neonatales entre primíparas y multíparas asistidas en domicilio

Objetivo: Comparar os resultados obstétricos e neonatais entre primíparas e multíparas assistidas no domicilio por enfermeiras obstétricas. Material e método: Estudo de corte transversal, que analisou prontuários de 100 partos de mulheres assistidas no domicílio e seus neonatos, de janeiro/2005 a dezembro/2009, em Santa Catarina, Brasil. Os dados coletados dos prontuários foram analisados por estatística descritiva e inferencial. Resultados: 73,0% das mulheres eram primíparas e 27,0% eram multíparas. Houve diferença estatisticamente significativa quanto ao tempo transcorrido entre a primeira avaliação e o parto, que foi menor nas multíparas (p=0,0402). O banho terapêutico de aspersão foi o método mais utilizado para o alívio da dor pelas primíparas (p=0,0015), assim como a escolha pelo parto vertical na água (p=0,0004). Não houve diferença estatisticamente significativa para as demais variáveis obstétricas e neonatais e na taxa de transferência para o hospital. Conclusão: Diferente de outros países, a maioria das mulheres assistidas no domicílio era primípara. O estudo indica bons resultados maternos e neonatais, tanto em primíparas quanto em multíparas, e são semelhantes aos de outros países.

Objective: To compare the obstetric and neonatal outcomes between primiparous and multiparous attended at home by obstetric nurses. Method: Cross sectional study, which examined 100 women attended births at home and their newborns from January 2005/December 2009, Brazil. The data collected from medical records were analyzed by descriptive and inferential statistics. Results: 73.0% of women were primiparous. There was statistically significant difference as to the time elapsed between the initial evaluation and delivery, which was smaller in multiparous (p=0.0402). The therapeutic bath of aspersion was the predominant method for pain relief by primiparous (p=0.0015), as well as the choice for vertical childbirth in water (p=0.0004). There was no statistically significant difference for the other obstetric and neonatal variables and in the transfer rate to hospital. Discussion and Conclusion: Different from other countries, the majority of women were primiparous. The results show good maternal and neonatal outcomes and are similar to those of other countries.

Objetivo: Comparar los resultados obstétricos y neonatales entre primíparas y multíparas atendidas en domicilio por enfermeras obstétricas. Material y método: Estudio de corte transversal, que examinó prontuarios de 100 mujeres que tuvieron sus partos en el hogar y sus recién nacidos de enero/2005 - diciembre/2009, Brasil. Los datos obtenidos de los registros médicos fueron analizados por estadística descriptiva e inferencial. Resultados: 73,0% de las mujeres eran primíparas. Hubo diferencia estadísticamente significativa en cuanto al tiempo transcurrido entre la evaluación inicial y el parto, que fue menor en multíparas (p = 0,0402). El baño terapéutico de aspersión fue el método predominante para el alivio del dolor por primíparas (p = 0,0015), así como la elección para el parto vertical en agua (p = 0,0004). No hubo diferencias estadísticamente significativas para las otras variables obstétricas y neonatales y en la tasa de transferencia al hospital. Conclusión: A diferencia de otros países, la mayoría de las mujeres eran primíparas. Los resultados muestran buenos resultados maternos y neonatales tanto en primíparas como en multíparas y son similares a los de otros países.

Fine needle aspiration cytology of lobular breast carcinoma and its variants.

OBJECTIVE: To identify associations between cytological criteria in fine needle aspiration (FNA) specimens and histological subtypes of lobular breast carcinoma (classical and other types). STUDY DESIGN: FNA cytology and mastectomy specimens from 72 cases of invasive lobular breast carcinoma were consecutively retrieved from the files of the Amaral de Carvalho Hospital, Jaú-São Paulo, Brazil. All cases were reviewed regarding five cytological criteria: cellularity, cellular cohesion, presence of inflammation, nucleoli and nuclear atypia. The χ2 test or Fisher's exact tests with 95% confidence intervals (CI) were used. RESULTS: The classical type showed lower initial cytological diagnosis of malignancy compared to the other variants (p=0.017; odds ratio (OR) 0.26, 95% CI 0.89-0.80). Moderate/intense cellular cohesion (p=0.011; OR 0.18, 95% CI 0.04-0.73) and mild atypia (p=0.000; OR 16.15, 95% CI 3.20-81.48) were significantly associated with the classical type of lobular breast carcinoma, while the absence of inflammation (p=0.082; OR 0.36, 95% CI 0.12-1.15) was marginally associated with the classical type. CONCLUSIONS: In cytology, the characterization of lobular carcinoma as malignant is difficult, especially the classical type. The association between cell cohesion and the classical type of lobular breast carcinoma may be one of the factors that complicate this diagnosis.