Breast - nonmalignant
Procedures
Cytology of breast lesions

Author: Hind Nassar, M.D. (see Authors page)

Revised: 25 July 2017, last major update April 2010

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Cytology [title] of breast lesions [title]

Cite this page: Cytology of breast lesions. PathologyOutlines.com website. http://pathologyoutlines.com/topic/breastcytology.html. Accessed October 23rd, 2017.
Definition / general
Terminology
  • Stereotactic (Greek / Latin: "touching in space") refers to sampling of nonpalpable or indistinct breast lesions using techniques that enable the spatial localization of the lesion within the breast
Fine needle aspiration (FNA)

False positives for malignancy:
  • Florid epithelial hyperplasia

False negatives:
Core biopsy imprint cytology
Ductal lavage cytology
Cytology touch imprints for margin evaluation
Recommendations
  • Fine needle aspiration preferred for benign appearing lesions, suspected recurrent disease (Diagn Cytopathol 2008;36:855), children / adolescents (Acta Cytol 2008;52:681) and clinically suspicious lymph nodes prior to neoadjuvant therapy
  • Use core biopsy for indefinite cases (Br J Cancer 2008;98:1182, Cytopathology 2008;19:271, Ann Surg Oncol 2009;16:281) or malignant appearing lesions
  • In United States, core biopsy has replaced FNA in many centers due to inability to diagnose invasive disease by FNA
  • Negative FNA should not rule out biopsy if clinical suspicion of malignancy persists but negative cytology, negative clinical examination and negative radiologic findings ("triple negative test") together have a negative predictive value close to 100% (Breast J 2004;10:487) [note: triple negative also refers to basal-like breast carcinomas that are ER-, PR- and HER2-]
  • Cytopathologists may be able to perform ultrasound guided FNAs and core biopsies (Diagn Cytopathol 2008;36:317, Diagn Cytopathol 2009;37:262)
FNA artifacts
Cytology description
  • Detailed analysis of a single morphologic characteristic has limited diagnostic value (Cancer 2005;105:152)
  • Helpful features for malignancy are cohesive clusters of tumor cells with irregular margins, pleomorphic cells with enlarged and hyperchromatic nuclei, mitotic figures, necrosis, microcalcifications, lack of naked nuclei and lack of apocrine metaplasia
  • In elderly patients, background of single epithelial cells with atypia and absence of bipolar nuclei in the background have a strong association with malignancy (Pathology 2008;40:573)
Cytology images

Images hosted on PathOut server:

Displaced epithelium #1

#2 - simulating vascular invasion

Displaced papillary carcinoma



Images hosted on other servers:

Lobular carcinoma of breast - various images

Core biopsy: malignant

Core biopsy: benign

Differential diagnosis of malignancy by cytologic examination