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Cherath SK, Chithrabhanu SM. Evaluation of Masood's and Modified Masood's Scoring Systems in the Cytological Diagnosis of Palpable Breast Lump Aspirates. J Clin Diagn Res 2017; 11:EC06-EC10. [PMID: 28571141 DOI: 10.7860/jcdr/2017/22817.9558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 01/03/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Fine Needle Aspiration Cytology (FNAC) has a leading role in the assessment of breast lesions. Masood's Scoring Index (MSI) and its modification (Modified Masood's scoring index; MMSI) has been proposed to aid in sub-grouping breast lesions and to help in subsequent management. AIM To assess and compare the diagnostic accuracy of MSI and MMSI by subsequent correlation with histopathology. MATERIALS AND METHODS The study was cross-sectional in nature and was conducted in a tertiary care setting. The study included 207 cases presenting as palpable breast lump, which had undergone FNAC and subsequent excision biopsy for histopathology. STATISTICAL ANALYSIS The cases were grouped into four categories as suggested by Masood et al., (MSI) and Nandini et al., (MMSI) and concordance analysis with reference to histopathological diagnosis was done. RESULTS In comparison to MSI, MMSI showed better concordance with histopathological diagnosis and superior diagnostic accuracy in non-proliferative breast disease category (p-value = 0.046) as well as in proliferative breast disease without atypia category. The overall diagnostic accuracy of the cytological scoring was 97.5%, with 94.5% sensitivity and 100% specificity. CONCLUSION Though both MSI and MMSI were found effective in subcategorizing breast lesions, MMSI was found to have better concordance with histopathology. Inclusion of cellular pattern and background material may further help in increasing the accuracy.
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Affiliation(s)
- Smrithi Krishna Cherath
- Consultant Pathologist, Department of Pathology, Moulana Hospital, Perinthalmanna, Kerala, India
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2
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Koike E, Iwaya K, Watanabe A, Miyake S, Sato E, Ishikawa T. Association between Breast Cancer Recurrence and Cellular Dissociation Assessed Using Fine-Needle Aspiration. Acta Cytol 2016; 60:413-420. [PMID: 27578393 DOI: 10.1159/000448508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/19/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the associations between breast cancer recurrence and cytological findings of fine-needle aspiration cytology (FNAC). STUDY DESIGN The study included 117 women who had undergone a modified radical mastectomy for invasive ductal carcinoma of the breast. FNAC samples of these patients were reexamined, and cytological findings, such as cellular dissociation, nuclear pleomorphism, nuclear atypia, chromatin pattern, and nuclear size, were scored. Uni- and multivariate analyses were performed to determine the prognostic significance of the cytological findings. Corresponding cancer tissues were immunostained for estrogen receptor, progesterone receptor, human epidermal growth factor 2 (HER2), p53, and E-cadherin to determine their associations with cytological findings. Coexpression of Arp2 and WAVE2 was also examined immunohistochemically as a cell locomotion signal. RESULTS Cellular dissociation (p = 0.0259) and nuclear size (p = 0.0417) were significantly associated with cancer recurrence. Multivariate analysis showed that cellular dissociation and histological grade were significant independent predictors of cancer recurrence. Cellular dissociation was found to be associated with coexpression of Arp2 and WAVE2 (p = 0.0356) and HER2 (p = 0.0469). CONCLUSION The cytological finding of cell dissociation was associated with the activation of Arp2 and WAVE2 signals and was an independent predictor of recurrence.
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Affiliation(s)
- Etsuko Koike
- Department of Pathology, SASAKI Institute, Kyoundo Hospital, Tokyo, Japan
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Fan F, Namiq AL, Tawfik OW, Thomas PA. Proposed prognostic score for breast carcinoma on fine needle aspiration based on nuclear grade, cellular dyscohesion and bare atypical nuclei. Diagn Cytopathol 2006; 34:542-6. [PMID: 16850493 DOI: 10.1002/dc.20529] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fine needle aspiration is an established diagnostic tool in breast carcinoma. Although the potential of using the same diagnostic aspirate material to provide additional cytomorphologic prognostic or predictive information has been investigated, no well-recognized, practical grading system has been established. Such system is necessary in guiding treatment, monitoring neoadjuvant chemotherapy effect and predicting outcome. We herein propose a new grading system, combining nuclear grade, cellular dyscohesion, and bare atypical nuclei to arrive at one cytoprognostic score. Cytoprognostic scores were compared with other known prognostic factors. Fine needle aspirations of breast diagnosed as adenocarcinoma from 55 patients were reviewed. The cytoprognostic score combined three features including nuclear grade (score 1-3), cellular dyscohesion (score 1-3), and bare atypical nuclei (score 0, 1). A cytoprognostic score of 3 and below was considered a low score, and a score of 4-7 was considered a high score. The cytoprognostic score was then compared to histologic grade, lymph node status, and expressions of estrogen receptor, progesterone receptor, Her2-Neu, Ki-67, and p53 in the subsequently excised tumor. A low cytoprognostic score predicted a low to intermediate grade carcinoma and a high score predicted an intermediate to high-grade carcinoma. A high cytoprognostic score also correlated with more positive lymph node metastasis, and poor expression of prognostic markers. In conclusion, cytoprognostic score is performed with ease and shows a great promise as a cost-effective way to predict biological behavior of breast carcinoma and guide clinical management.
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Affiliation(s)
- Fang Fan
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas 66160-7417, USA.
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Khan MZ, Haleem A, Al Hassani H, Kfoury H. Cytopathological grading, as a predictor of histopathological grade, in ductal carcinoma (NOS) of breast, on air-dried Diff-Quik smears. Diagn Cytopathol 2004; 29:185-93. [PMID: 14506669 DOI: 10.1002/dc.10285] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fine-needle aspiration cytology (FNAC) is a widely practiced technique in the diagnosis of breast carcinoma, and it is the only diagnostic procedure performed before definitive treatment, at most institutions. While the histological grading of breast carcinoma has become routine in many centers worldwide, the cytopathological grading of breast carcinoma is not commonly used. Grading of breast carcinoma, while the tumor is still in vivo, would be the most ideal and desirable situation, as it would be helpful in the selection of patients for appropriate therapy. The objective of this study, therefore, was to devise a simple system for grading breast carcinoma, based on the cytological features alone. We reviewed 125 cases of breast carcinoma retrospectively, which were initially diagnosed by FNAC, with subsequent histopathological confirmation. These included 105 ductal, 6 lobular, 2 tubular, 1 papillary, and 1 medullary carcinoma. There was 1 ductal carcinoma in situ. Nine cases were rendered insufficient for grading. Thus 105 cases of ductal carcinoma (NOS) were evaluated for final cytological grading. Air-dried Diff-Quik-stained smears were reviewed at least twice independently by four histopathologists and were then compared with the original histological grades. Six cytological features used for grading were found to be statistically significant: cellular pleomorphism, nuclear size, nuclear margin, nucleoli, naked tumor nuclei, and mitoses. A scoring system based on these six essential parameters was used, to classify ductal carcinoma into three cytological grades, which showed close correlation with the established histological grades. In addition, two less consistent, but still important, features were the presence or absence of necrosis and stromal invasion. Another six parameters, including smear cellularity, degree of cell dispersion or clustering, lymphoplasmacytic infiltrate, presence of tubular structures, cytoplasmic appearance of the tumor cells, and smear background, were not statistically significant. However, these additional parameters were found helpful in assigning the correct grade, in cases with borderline scores. The concordance rate with histology was 100% for grade 1, 98% for grade 2, and 93% for grade 3.
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Affiliation(s)
- M Z Khan
- Department of Pathology, Division of Histopathology, Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia.
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5
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Suzuki M, Oshida M, Nagashima T, Hashimoto H, Yagata H, Nakajima N. Quantitative morphometric analysis of fine needle aspirates of breast carcinoma. Breast Cancer 2001; 8:138-45. [PMID: 11342987 DOI: 10.1007/bf02967493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reports of morphometric analysis using computerized digitized images of fine needle aspirates of breast cancer are rare. We aimed to evaluate whether quantitative morphometric estimations of cytological nuclear features could be used for preoperative prediction of the risk of recurrence as well as chemosensitivity. METHODS Seventy consecutive breast cancer patients were treated with preoperative chemotherapy (Doxifluridine 800 mg/body/day, orally) for 4 weeks and subsequently they underwent surgery. Using Papanicolaou-stained cytological materials, computerized morphometric analyses were performed. Mean nuclear area (NA) was measured and the coefficient of variation of NA (NACV) was calculated as the quantitative parameter of nuclear atypism. NA and NACV were compared with prognostic factors (tumor size, histological grade, hormone receptor status, nodal status, and ploidy status), and with the response to the chemotherapy. RESULTS NA and NACV were significantly associated with hormone receptor status and ploidy status (p<0.05). NACV correlated with histological grade (p<0.05). Neither NA nor NACV were associated with tumor size and nodal status. Patients with high NACV (>35%) had lower rates of disease-free survival (p<0.05) than those with low NACV (< or =35%). Responders to preoperative chemotherapy had statistically larger NA, higher NACV and higher S-phase fraction at the time of diagnosis compared with non-responders (p<0.001, p<0.0005, and p<0.05 respectively). CONCLUSIONS Morphometric analysis of preoperative fine needle aspirates reflects important clinical information, such as the risk of recurrence, and particularly, chemosensitivity.
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Affiliation(s)
- M Suzuki
- The First Department of Surgery, Chiba University School of Medicine, Japan
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Skrbínc B, Babic A, Cúfer T, Us-Krásovec M. Cytological grading of breast cancer in Giemsa-stained fine needle aspiration smears. Cytopathology 2001; 12:15-25. [PMID: 11256933 DOI: 10.1046/j.1365-2303.2001.00297.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A potential cytological nuclear grading based on a semi-quantitative evaluation of three basic nuclear features, size of cell nuclei, anisonucleosis and the proportion of nucleoli-containing-nuclei, was tested on 74 Giemsa-stained fine needle aspiration of breast smears for its reliability in establishing the malignant potential of breast cancer. The prognostic impact of DNA-ploidy and S-phase fraction was also assessed. A good correlation between the three basic nuclear features, DNA-ploidy, S-phase fraction, cytological nuclear grade and histological grade, was shown. Using the cytological nuclear grade proposed, correct classification of cases between low histological grade (HG I) and high histological grade (HG II + HG III) was achieved in 79.73%. A statistically significant difference in 5-year survival rate was also observed between low malignancy grade and high malignancy grade breast cancer patients, regardless of the grading method used. DNA-ploidy and S-phase fraction were not statistically significant in establishing the malignant potential of breast cancer.
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MESH Headings
- Azure Stains
- Biopsy, Needle
- Breast Neoplasms/classification
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Breast Neoplasms/physiopathology
- Carcinoma, Ductal, Breast/classification
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/physiopathology
- Cell Nucleus/pathology
- DNA, Neoplasm/analysis
- Female
- Humans
- Ploidies
- Prognosis
- Survival Rate
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Affiliation(s)
- B Skrbínc
- Department for Medical Oncology, Institute of Oncology, Ljubljana, Slovenia
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Robinson IA, McKee G, Kissin MW. Typing and grading breast carcinoma on fine-needle aspiration: is this clinically useful information? Diagn Cytopathol 1995; 13:260-5. [PMID: 8575287 DOI: 10.1002/dc.2840130315] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The ability of fine-needle aspiration (FNA) to diagnose breast cancer is beyond question. The established role of cytopathology is to maintain a low benign to malignant biopsy ratio by reducing the number of benign lesions excised. Both typing and grading of breast cancers on FNA have received attention in the cytology literature but how this knowledge can influence management has not been fully explored. Recently we described a method for the cytological grading of breast cancer that compares well with the established Bloom and Richardson grades. In this paper we present our experience of 1,387 breast cancer FNAs reported by us with histological verification. We show that cytologically typing and grading breast cancers are valid exercises that can predict the true nature of the neoplasm. This information may assist in the clinical approach to the malignant breast.
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Affiliation(s)
- I A Robinson
- Department of Cytopathology, Royal-Surrey County Hospital, Guildford, United Kingdom
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Idvall I, Fernö M, Sigurdsson H, Åkerman M, Killander D. Fine needle aspiration cytology of breast carcinoma: a pre-operative prognostic tool? Breast 1995. [DOI: 10.1016/0960-9776(95)90075-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Robinson I, McKee G. Cytological scoring system in primary breast cancer. Cytopathology 1995; 6:130-2. [PMID: 7795165 DOI: 10.1111/j.1365-2303.1995.tb00462.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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10
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Robinson I, McKee G. Cytological grading of breast carcinoma. Diagn Cytopathol 1995; 12:191-3. [PMID: 7774505 DOI: 10.1002/dc.2840120224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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de Graaf H, Willemse P, Laddé BE, Van den Bergen HA, Krebber M, Tjabbes T, Sluiter WJ. Evaluation of a cytological scoring system for predicting histological grade and disease-free survival in primary breast cancer. Cytopathology 1994; 5:294-300. [PMID: 7819514 DOI: 10.1111/j.1365-2303.1994.tb00433.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A simple cytological scoring system was evaluated as a method of predicting histological grade and disease-free survival in 79 patients with primary breast cancer. The mitotic activity index and oestrogen receptor status were also assessed for their predictive value. The concordance between cytological scores and histological grades was good (80%) for low-grade lesions, but poor (45%) for high-grade lesions. Similar results were found using the mitotic activity index as a prognostic indicator. Cytological grading was not found to be an independent prognostic indicator after a median follow up of 8 years.
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Affiliation(s)
- H de Graaf
- Department of Histopathology, Sophia Hospital, Zwolle, The Netherlands
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Robinson IA, McKee G, Nicholson A, D'Arcy J, Jackson PA, Cook MG, Kissin MW. Prognostic value of cytological grading of fine-needle aspirates from breast carcinomas. Lancet 1994; 343:947-9. [PMID: 7909010 DOI: 10.1016/s0140-6736(94)90066-3] [Citation(s) in RCA: 123] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Because neoadjuvant therapy, including preoperative chemotherapy and tamoxifen, is becoming increasingly common for early breast cancer, it is desirable to grade tumours before surgery so that the most appropriate medical regimen can be selected. We have used a cytological grading system for ductal carcinoma of type not otherwise specified (NOS). Wet-fixed Papanicolaou-stained breast aspirates are examined for the extent of cell dissociation, cell size and uniformity, and the appearance of nucleoli, the nuclear margin, and chromatin. 377 invasive breast carcinomas were removed after preoperative diagnostic fine-needle aspiration cytology (FNAC) during the 25 months of the study. 286 tumours were ductal carcinomas NOS on histology. We established three cytological grades and found that cytological grade corresponded well with the established histological grades (Elston's modified Bloom and Richardson method). All cytological features included in the score were equally important on regression analysis. This study shows that grading of breast cancer on FNAC is feasible and reproducible. Cytological grade may substitute for histological grade, so a combination of FNAC and mammography can provide information on tumour type, grade, and size before surgery. We recommend this grading system to centres that use FNAC for the diagnosis of breast cancers.
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Affiliation(s)
- I A Robinson
- Department of Cytopathology, Royal Surrey County Hospital, Guildford, UK
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Hitchcock A, Hunt CM, Locker A, Koslowski J, Strudwick S, Elston CW, Blamey RW, Ellis IO. A one year audit of fine needle aspiration cytology for the pre-operative diagnosis of breast disease. Cytopathology 1991; 2:167-76. [PMID: 1954318 DOI: 10.1111/j.1365-2303.1991.tb00402.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In 1988, 985 patients presenting with breast disease, most with a palpable abnormality, were investigated by the triple approach (clinical examination, imaging and fine needle aspiration cytology [FNAC]). Using FNAC, 28% of patients were diagnosed as having carcinoma, 45% benign disease, 4% had suspicious cytology and 3% equivocal cytology. The remaining 20% had inadequate aspirates. Two false positive diagnoses of carcinoma were made (a false positive rate of 0.7%); one was a case of high grade non-Hodgkin's lymphoma and the other a papillary lesion with epithelial atypia. The false negative rate was 6.4%. Of these 49 patients, six had carcinoma-in-situ and 19 had low grade tumours. The absolute and complete sensitivities for the diagnosis of carcinoma in this series were 84.7% and 91.9% respectively and the absolute and complete specificities 99.7% and 98.3%, respectively. These figures compare favourably with those from other centres and confirm the efficacy of FNAC as part of the triple approach to the diagnosis of breast disease. The use of FNAC has resulted in a reduction in the number of Trucut and frozen section biopsies performed. Eighty three per cent of the patients with benign disease diagnosed by the triple approach have avoided excision biopsy, none of whom have subsequently been found to have carcinoma. Eighty patients with advanced breast carcinoma were spared operative intervention.
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Affiliation(s)
- A Hitchcock
- Department of Pathology, City Hospital, Nottingham
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Hunt CM, Ellis IO, Elston CW, Locker A, Pearson D, Blamey RW. Cytological grading of breast carcinoma--a feasible proposition? Cytopathology 1990; 1:287-95. [PMID: 2101675 DOI: 10.1111/j.1365-2303.1990.tb00362.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Fine needle aspiration cytology (FNAC) of the breast is widely used in the diagnosis of breast carcinoma. In some centres this is sometimes the only diagnostic procedure performed prior to definitive treatment. A grading system based on cytology would be helpful in the selection of patients for appropriate therapy. The aim of this study, therefore, was to devise such a system for grading breast carcinoma based on cytological features alone. The features assessed were the degree of cell clustering, nuclear pleomorphism, nuclear diameter, the presence of multiple, easily visible nucleoli and necrosis. Cytological features were compared to the histological grade of the tumours following excision. Discriminant analysis showed that the features with the closest correlation with histological grade were nuclear diameter, nuclear pleomorphism and the presence of nucleoli. A scoring system based on these three parameters enabled the classification of tumours into high and low cytological grades which showed a close correlation with histological grade.
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Affiliation(s)
- C M Hunt
- Department of Histopathology, City Hospital, Nottingham
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Zuk JA, Maudsley G, Zakhour HD. Rapid reporting on fine needle aspiration of breast lumps in outpatients. J Clin Pathol 1989; 42:906-11. [PMID: 2677052 PMCID: PMC501786 DOI: 10.1136/jcp.42.9.906] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A retrospective analysis of the performance and value of fine needle aspiration of symptomatic breast masses in a special outpatient "breast clinic" within a district general hospital was carried out. All but a few aspirations were performed by a group of histopathologists, with, immediate cytological reporting. Fine needle aspiration was more sensitive for detecting malignancy than clinical assessment alone, the sensitivity increasing with the experience of the aspirator. The results compared favourably with those in reported series from specialist centres in the United Kingdom. The value of fine needle aspiration extends to the overall management of patients with breast masses but the results must be assessed in conjunction with the clinical context in view of the possibility of false negative or, more rarely, false positive cytological diagnoses.
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Affiliation(s)
- J A Zuk
- Department of Histopathology, Arrowe Park Hospital, Upton, Wirral, Merseyside
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