Cytological grading of breast carcinoma on fine needle aspirates and its relation with histological grading

Diagnosis of Infarcted Breast Lesions on FNAC, a Blustering Fool: Short Case Series

Introduction

Fine-needle aspiration cytology (FNAC) is often used as a screening tool. Cytopathologist should be aware of various mimickers of the malignancy. One of these is infarction of benign breast lesions. Careful examination of cytomorphological features will avoid the misdiagnosis of malignancy in such cases.

Material and Methods

Six cases were diagnosed as benign breast lesion for 4 years and 5 months in our newly established tertiary referral center. Histopathology follow-up was available in one case.

Results

Of six cases, three cases (50%) were reported as fibroadenoma with infarction, two cases (33%) as benign breast lesion with infarction favor fibroadenoma, and one as breast lesion with infarction favor phyllodes tumor in view of recurrence. Most were in the second or third decade of their life. All cases showed dyscohesive cells with pyknotic nuclei. Monolayered sheets of necrotic cells were seen in the four cases (66%). Viable cells were seen in four cases.

Conclusions

FNAC provides a rapid and accurate diagnosis of benign breast lesions with infarction in the hands of experienced pathologists who can help in better patient care. Small-sized uniform pyknotic nuclei of dyscohesive cells and regular nuclear membranes help to differentiate them from inflammatory and malignant lesions.

Accuracy of cytological grading in the carcinoma breast and its correlation with pathological prognostic parameters

BACKGROUND

Breast carcinoma is a significant contributor to cancer deaths worldwide. Tumor grade is an important parameter in planning out the treatment. Histology is the gold standard for grading the carcinoma breast. However, fine-needle aspiration cytology (FNAC) is still an important first-line diagnostic procedure in many parts of the world. Grading on cytology will help in pre-operative management. Although cytological grading of the carcinoma breast is a topic of research for many years, it is not yet included as a part of routine cytology reports.

MATERIALS AND METHODS

A prospective study was conducted over a period of 1 year at Kalinga Institute of Medical Sciences. A total of 42 cases of carcinoma breast, diagnosed on FNAC and subsequently confirmed on histology, were included. Cytological grading was performed using Robinson's grading system, and the results were compared with the histological grade. Also, the cytological grades were correlated with various pathological prognostic parameters such as tumor size, lymph node status, lympho-vascular invasion, estrogen and progesterone receptor status, Her-2-neu expression, and Ki-67 index. The kappa measure of agreement and Fisher's exact test were used for statistical analysis.

RESULTS

A moderate kappa measure of agreement (k = 0.415) was found between cytological and histological grades with an overall concordance rate of 66.67%. The accuracy of cytological grading was higher with increasing cytological grade. Except for estrogen receptor expression, none of the other prognostic parameters have a statistically significant correlation with cytological grade.

CONCLUSIONS

Tumor grading on cytology can be helpful in planning treatment, especially in resource-constrained settings. Subjective variation in assessing different parameters and non-inclusion of mitosis in this system might be the reasons behind wrong grading in some cases. Inclusion of mitosis in the scoring system can improve the accuracy of cytological grading and its importance in prognosis.

Cytological Grading of Breast Carcinomas and Its Prognostic Implications

Introduction

Determining the histological grade of breast carcinomas before mastectomy is necessary to decide about neoadjuvant chemotherapy. Core needle biopsies used for this purpose often under-grade the tumour. The grade obtained from fine needle aspiration cytology samples will help in such situations and whenever biopsy is not done, as in a resource-poor setup. Many studies are being done to find out the cytological grading system that correlates well with histological grading.

Methods

This study was done between 2016 and 2019 including the cases in which both modified radical mastectomy and fine needle aspiration of the tumour had been done. Robinson’s cytological grading was done in Papanicolaou and haematoxylin & eosin (H&E) stained cytology smears and correlated with modified Bloom-Richardson histologic grading done in modified radical mastectomy specimens. We also studied the prognostic significance of Robinson’s method by studying the association between cytological grade and lymph node metastasis.

Results

Sixty cases were studied. The two methods had the same grade in 49 (81.7%) cases. They showed a significant positive correlation (Spearman correlation coefficient 0.848, p-0.0001), significant association (Chi-square test, p-0.0001), and substantial agreement (kappa value 0.72). Multiple regression analysis showed chromatin score and nucleoli score as the most influential parameters. Lymph node metastasis showed significant association with cytological grade (p-0.0003), cell dissociation score (p-0.0001), nucleoli score (p-0.01), and chromatin score (p-0.04).

Conclusion

Robinson’s cytological grading is a simple, reliable adjunct/alternative to core needle biopsies for grading breast carcinomas before mastectomy. Hence, it can be made a part of routine cytology reporting of breast carcinomas. Further long-term studies will help in confirming its prognostic significance.

The Prognostic Significance of Anisomycin-Activated Phospho-c-Jun NH2-Terminal Kinase (p-JNK) in Predicting Breast Cancer Patients' Survival Time

This study aims to investigate the prognostic significance of p-JNK in breast cancer patients receiving neoadjuvant chemotherapy (NACT) and analyze the relationship between anisomycin, p-JNK. A total of 104 breast cancer patients had NACT were enrolled in this study. The western blot and immunohistochemistry assays were used to determine the protein expressions of p-JNK in human breast cancer cell lines and patients’ cancer tissues. The chi-square test and Fisher’s exact test were adopted to gauge the associations between breast cancer and clinicopathological variables by p-JNK expression, whereas the univariate and multivariate Cox proportional hazards regression models were used to analyze the prognostic value of p-JNK expression. The Kaplan-Meier plots and the log-rank test were adopted to determine patients’ disease-free survival (DFS) and overall survival (OS). Findings indicated that the p-JNK expression had prognostic significance in univariate and multivariate Cox regression survival analyses. Results of log-rank methods showed that: (1) the mean DFS and OS times in patients with high p-JNK expression were significantly longer than those in patients with low p-JNK expression (χ² = 5.908, P = 0.015 and χ² = 6.593, P = 0.010, respectively). p-JNK expression is a significant prognostic factor that can effectively predict the survival in breast cancer patients receiving NACT. Treatment with the JNK agonist anisomycin can induce apoptosis, lead to increased p-JNK expression and decreased p-STAT3 expression. Moreover, the p-JNK expression was inversely correlated with p-STAT3 expression.

Pre-treatment systemic immune-inflammation index is a useful prognostic indicator in patients with breast cancer undergoing neoadjuvant chemotherapy

The systemic immune‐inflammation index (SII = N × P/L) based on neutrophil (N), platelet (P) and lymphocyte (L) counts is used to predict the survival of patients with malignant tumours and can fully reflect the balance between host inflammatory and immune status. This study is conducted to explore the potential prognostic significance of SII in patients with breast cancer undergoing neoadjuvant chemotherapy (NACT). A total of 262 patients with breast cancer received NACT were enrolled in this study. According to the receiver operating characteristic curve, the optimal cut‐off value of SII was divided into two groups: low SII group (<602 × 10⁹/L) and high SII group (≥602 × 10⁹/L). The associations between breast cancer and clinicopathological variables by SII were determined by chi‐squared test or Fisher's exact test. The Kaplan‐Meier plots and log‐rank test were used to determine clinical outcomes of disease‐free survival (DFS) and overall survival (OS). The prognostic value of SII was analysed by univariate and multivariate Cox proportional hazards regression models. The toxicity of NACT was accessed by National Cancer Institute Common Toxicity Criteria (NCICTC). According to univariate and multivariate Cox regression survival analyses, the results showed that the value of SII had prognostic significance for DFS and OS. The patients with low SII value had longer DFS and OS than those with high SII value (31.11 vs 40.76 months, HR: 1.075, 95% CI: 0.718‐1.610, P = .006; 44.47 vs 53.68 months, HR: 1.051, 95% CI: 0.707‐1.564, P = .005, respectively). The incidence of DFS and OS in breast cancer patients with low SII value was higher than that in those patients with high SII value in 3‐, 5‐ and 10‐year rates. The common toxicities after NACT were haematological and gastrointestinal reaction, and there were no differences by SII for the assessment of side effects of neoadjuvant chemotherapy. Meanwhile, the results also proved that breast cancer patients with low SII value and high Miller and Payne grade (MPG) survived longer than those breast cancer with high SII value and low MPG grade. In patients without lymph vessel invasion, these breast cancer patients with low SII value had better prognosis and lower recurrence rates than those with high SII value. Pre‐treatment SII with the advantage of reproducible, convenient and non‐invasive was a useful prognostic indicator for breast cancer patients undergoing neoadjuvant chemotherapy and is a promising biomarker for breast cancer on treatment strategy decisions.

Usefulness of Cytological Scoring Method by Breast Fine Needle Aspiration Cytology on Breast Duct Dilatation and Cystic Lesions

Aim

The objective of this study was to apply a scoring method to fine needle aspiration cytology on breast duct dilatation and cystic lesions, to set an optimum cut-off value to differentiate between benign and malignant cases, and to identify features useful for cell judgment.

Materials and Methods

Samples were 23 preparations of specimens (12 benign and 11 malignant cases) suspected with intraductal lesions or cystic change by ultrasonography or mammography and cytology. The scoring system comprised the following 10 items, and each item was scored 1-3, with a total score of 10-30. Three items were concerning structural atypia: 1, scattered epithelial cells; 2, uneven irregular cluster edge; and 3, overlapping nuclei of epithelial cells, and seven items were concerning cellular atypia: 4, irregular nuclear size; 5, irregular nuclear morphology; 6, deep dyeing chromatin; 7, chromatin granularity; 8, chromatin distribution; 9, nucleolus; and 10, absence of myoepithelial cells.

Results

(1) Scoring cut-off value: malignancy is to be suspected when the score is 20.75 or higher (diagnostic accuracy: 95.7%). (2) Findings useful for cancer judgment: the sensitivity of the following four findings was high: uneven irregular cluster edge, irregular nuclear overlapping, chromatin granularity, and absence of myoepithelial cells. (3) Correlation among the findings: the findings correlated with malignancy were as follows: scattered epithelial cells versus uneven irregular cluster edge (rs = 0.8).

Conclusion

Cytological evaluation by scoring lesions accompanied by intraductal dilatation and cystic change was a useful method capable of differentiating between benign and malignant cases at a high accuracy.

MicroRNA-671-3p inhibits the development of breast cancer: A study based on in vitro experiments, in-house quantitative polymerase chain reaction and bioinformatics analysis

MicroRNAs (miRNAs or miRs) are highly conserved small noncoding RNA molecules involved in gene regulation. An increasing number of studies have demonstrated that miRNAs act as oncogenes or antioncogenes in various types of cancer, including breast cancer (BC). However, the exact role of miR‑671‑3p in BC has not yet been reported. In the present study, in vitro experiments were implemented to explore the effects of miR‑671‑3p on the proliferation and apoptosis of BC cells, and reverse transcription‑quantitative polymerase chain reaction was conducted using in‑house clinical BC samples to address the expression level and clinical value of miR‑671‑3p in BC. Simultaneously, miR‑671‑3p target genes were collected, and subsequent bioinformatics analyses were executed to probe the potential signaling pathway through which miR‑671‑3p influenced the occurrence and progression of BC. According to the results, the expression level of miR‑671‑3p was lower in BC tissues compared with that in adjacent non‑tumorous tissues (P=0.048), and the area under the curve was 0.697 (95% confidence interval=0.538‑0.856), with a sensitivity and specificity of 0.818 and 0.579, respectively. Forced miR‑671‑3p expression in the BC cell line MDA‑MB‑231 evidently arrested cell proliferation and induced cell apoptosis. Furthermore, in silico enrichment analyses suggested that miR‑671‑3p may be involved in the initiation and progression of BC through the targeting of genes associated with the Wnt signaling pathway. In conclusion, the present study findings suggested that miR‑671‑3p may function as a tumor suppressor in BC by influencing the Wnt signaling cascade, which provides a prospective molecular target for the therapy of BC.

Diagnostic efficacy of smear cytology and Robinson's cytological grading of canine mammary tumors with respect to histopathology, cytomorphometry, metastases and overall survival

Cytology is a simple, rapid, and inexpensive method used for pre-operative diagnosis of canine mammary tumors (CMTs) in veterinary practice. Studies related to human breast cancer showed the Robinson’s grading system—established for invasive ductal carcinoma, not otherwise specified (IDC, NOS) and used on cytological material—to not only closely correspond to the histopathological grading but also be helpful in assessing prognosis and selecting most suitable treatments before surgery. The objectives of this study were: to evaluate the accuracy of cytological diagnosis and cytological Robinson’s grading system compared to the histopathological examination of CMTs; to compare of cytological features and cytomorphometric parameters with tumor behavior, as well as cytological and histological grading; and to determine an association of the Robinson’s grading system and cytological background details with metastases, and patients’ survival. We report substantial diagnostic accuracy in detecting simple types and high grade tumors. Cytological diagnosis of tumor behavior showed relatively low sensitivity and specificity compared to human studies, and this might be caused by the heterogeneous morphology of CMTs. The presence of mucosecretory material and extracellular matrix was not significantly associated with tumor behavior. We report a positive correlation between both grading systems and cytological features (included in Robinson’s grading), the presence of necrotic debris, inflammation, and red blood cells. A negative correlation was determined only for the presence of extracellular matrix. The univariate and multivariate analyses confirmed a significantly higher risk of developing metastasis and shorter overall survival for dogs with tumors of grade 2 or 3 on cytology. In addition, these tumors were the most common cause of CMT-related deaths in dogs. Taken together, our findings suggest that the Robinson’s method of cytological grading applied for malignant CMTs evaluated in cytological smears regardless of tumor type can be adapted to veterinary cytology. Additionally, some background features seem to aid malignancy assessment.

Comparative evaluation of six parametric Robinson and three parametric Howell's modification of Scarf-BloomRichardson grading method on breast aspirates with histopathology: A prospective study

Background:

Fine needle aspiration cytology (FNAC) is a quick method to assess the tumor grade before its removal which will help clinicians to decide on the appropriate neo adjuvant therapy. This is essentially true in developing countries where core needle biopsy still is not used as a standard practice to sample breast carcinoma. Assessment of biological aggressiveness by cytological grading (CG) without removing the would be of immense value. The National Cancer Institute, Bethesda, sponsored conference had recommended that tumor grading on FNA material should be incorporated in cytology reports for prognostication.

Aim:

The present study was carried out to evaluate which among the two, five parametric Robinson or three parametric Scarf–BloomRichardson (SBR) cytology grading method corresponds better with the histological grading (HG) in breast carcinoma.

Materials and Methods:

FNAC of 150 cases of ductal carcinoma breast with subsequent histological confirmation was studied to assess the tumor grade on cytology by two distinct methods Robinson and Howell's modification of SBRmethod and then correlated with histologic grade.

Results:

Comparative analysis revealed concordance of 76% by Robinson and 68% by SBR with Kappa value of 0.6683 and 0.4505 and diagnostic accuracy of 86.7% and 78.7%, respectively.

Conclusions:

We conclude that Robinson method showed a better correlation and higher kappa value of agreement in comparison with SBR method. Robinson method of CG is simpler, objective, and easily reproducible for grading breast carcinomas.

Combined Use of Unguided FNA and CNB Increases the Diagnostic Accuracy for Palpable Breast Lesions

BACKGROUND

Obtaining nonsurgical precise diagnosis of a palpable breast lesion is of paramount importance. Both core needle biopsy (CNB) and fine needle aspiration (FNA) are validated techniques used for this purpose. In this study, we compared the accuracy of both methods and explored whether combining both tests adds significant diagnostic value, and for the first time, we tested the concordance of tumor grading in parallel biopsies with reference to surgical excision (SE).

METHODS

Patients underwent concurrent unguided FNA and CNB followed by SE were retrospectively recruited. Chi-square was used to compare the accuracy of malignancy detection, and tumor grade agreement was calculated using kappa (k) statistical test with reference to SE findings.

RESULTS

All patients were females (n: 170). The median age was 45 years. Excluding 18 cases which had inadequate FNA, accuracy of FNA and CNB was 86.2% and 79.6%; respectively. Accuracy was 94.1% when we considered both tests together for any positive result. For tumor grading, the agreement was 91.6% for CNB and 98.8% for FNA.

CONCLUSION

Diagnostic strength was comparable for both FNA and CNB, slightly more favorable for the former. Combination of both tests significantly minimized missing cases as false negative. When available, it is worthy to grade malignant FNA samples. Diagn. Cytopathol. 2016;44:578-581. © 2016 Wiley Periodicals, Inc.