Utility of Cytological Grading in Proliferative Epithelial Lesions of Breast
Keywords:
Breast carcinoma, Fine needle aspiration cytology, Cytological grading
Abstract
Background: Breast carcinoma is the second most common malignancy in women. Fine needle aspiration cytology of breast is rapid, reliable and safe diagnostic tool to distinguish between neoplastic and non neoplastic lesions. Cytological grading of the smears can provide valuable prognostic information. AIMS AND OBJECTIVES: To study the utility of Masood cytological grading system and to compare it against a new proposed cytological grading system in proliferative epithelial lesions of breast. Methods: The Papanicolaou (PAP) stained Fine Needle Aspiration Cytology (FNAC) smears of proliferative breast lesions were cytologically graded by the Masood cytological grading system and by the newly proposed grading system by two observers independently. Results were correlated with the histopathological diagnosis. Result: In the study period of 2 years, 54 proliferative epithelial lesions were studied of which 47 were proliferative breast disease without atypia and seven proliferative breast diseases with atypia. 42/54 cases in newly proposed system showed concordance with existing Masood grading system. p-value is 0.000 (< 0.005) which is significant. Sensitivity, specificity, positive predictive value and negative predictive value for newly proposed grading system were 88.67%, 100%, 100% and 85.71% respectively. Conclusion: A simple slide based scoring system of epithelial lesions of breast is a useful tool in the prognostication and prediction of behavior of proliferative epithelial lesions.References
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Indian J Cancer 2011;48:240-5
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mammographically guided fine-needle aspirates. Diagn Cytopathol. 1991;7:581–
90.
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aspiration cytology samples for the detection of non-high-grade ductal breast
carcinoma. Oncocytology Journal 2013;3:1–7.
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diseases among female patients at a sub Saharan Africa tertiary hospital: A
cross sectional study. BMC Surgery 2013; 13:9.
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Two Cytological Grading Systems in Breast Carcinoma with Histological Grading:
An Important Prognostic Factor. Analytical Cellular Pathology 2014;1-6
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Distinction of phylloides tumor from fibroadenoma: Cytologists' perspective. J
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Prognostic value of cytological grading of fine-needle aspirates from breast
carcinomas. Lancet 1994; 343:947-9.
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Rural India. The Internet Journal of Pathology 2012;13(3):1-5.
27. Choi YD, Choi YH, Lee JH, Nam JH, Juhng SW, Choi C. Analysis of fine needle
aspiration cytology of the breast. Acta Cytol. 2004;48(6):801-6.
with their histological correlation. Int J Med Sci Public Health 2014;3:181-5.
2. Einstien D, Omprakash BOP, Ganapathy H and Rahman S. “Comparison of 3-
Tier Cytological Grading Systems for Breast Carcinoma”. ISRN Oncology
2014;1-6. doi:10.1155/2014/252103
3. Jarwani PB, Patel DC, Patel SM, Dayal A. Fine Needle Aspiration Cytology in A
Palpable Breast Lump. GCSMC J Med Sci 2013;2:12-6.
4. Bansal C, Pujani M, Sharma KL, Srivastava AN, Singh US. Grading systems in
the cytological diagnosis of breast cancer: A review. J Can Res Ther
2014;10:839-45.
5. Nandini N M, Rekha T S, Manjunath G V. Evaluation of scoring system in
cytological diagnosis and management of breast lesion with review of literature.
Indian J Cancer 2011;48:240-5
6. Phukan JP, Sinha A, Deka JP. Cytological grading of breast carcinoma on fine
needle aspirates and its relation with histological grading. South Asian J Cancer
2015;4:32-4.
7. Masood S, Frykberg ER, McLellan GL, Dee S, Bullard JB. Cytologic
differentiation between proliferative and nonproliferative breast disease in
mammographically guided fine-needle aspirates. Diagn Cytopathol. 1991;7:581–
90.
8. Sidawy MK, Stoler MH, Frable WJF, et al. Interobserver variability in the
classification of proliferative breast lesions by fine-needle aspiration: Result of
the Papanicolaou Society of Cytopathology study. Diagn Cytopathol
1998;18:150-65.
9. Lester SC. The Breast. In: Kumar V, Abbas A.K, Fausto N, Aster J.C editors.
Robbins and cotron pathologic basis of disease. 9th ed. Philadelphia: Saunders
Elsevier; 2010. P 1044-70.
10. Ryu A, Takenaka A, Nagata S, Tomita Y. Scoring system of fine needle
aspiration cytology samples for the detection of non-high-grade ductal breast
carcinoma. Oncocytology Journal 2013;3:1–7.
11. Okoth C, Galukande M, Jombwe Jand Wamala D. Benign proliferative breast
diseases among female patients at a sub Saharan Africa tertiary hospital: A
cross sectional study. BMC Surgery 2013; 13:9.
12. Gangopadhyay M, Nijhawan R, Joshi K, and Gupta S. Cytology of “Significant” Breast Ductal Proliferations. Acta Cytol 1997;41(4):1112-20.
13. Singh P, Chaudhry M, Nauhria S, Rao D. Cytomorphological patterns of breast lesions diagnosed on fine-needle aspiration cytology in a tertiary care hospital. Int J Med Sci Public Health 2015;4(5):674-9.
14. Pandey P, Dixit A, Chandra S, Kaur S. A Comparative and Evaluative Study of
Two Cytological Grading Systems in Breast Carcinoma with Histological Grading:
An Important Prognostic Factor. Analytical Cellular Pathology 2014;1-6
15. Bibbo M, Wilbur DC, Comprehesive Cytopathology, 3rd ed. Philadelphia:
Saunders Elsevier; 2008.p 713-50.
16. Orell SR, Sterret GF, Whitaker D. Fine needle aspiration cytology, 4th ed,
Churchill Livingstone: Elsevier, 2005:165-201.
17. Mendoza P, Lacambra M, Tan PH, Tse GM. Fine needle aspiration cytology of the breast: The nonmalignant categories. Pathology Research International
2011;1-8.
18. Bandyopadhyay R, Nag D, Modal SK, Mukhopadhyay S, Roy S, Sinha SK.
Distinction of phylloides tumor from fibroadenoma: Cytologists' perspective. J
Cytol. 2010; 27(2):59-62.
19. Corder AP, Carpenter R, Smallwood JA, Johnson CD. Fibroadenosis of the
breast does not require excision biopsy. Postgrad Med J 1990;66:650–3.
20. Zoah C, Raza A, Martin SE, Pan J, Greaves TS, Cobb CJ et al. Breast FineNeedle Aspiration Samples Reported as ‘‘Proliferative Breast Lesion’’: Clinical Utility of the Subcategory ‘‘Proliferative Breast Lesion With Atypia’’. Cancer Cytopathol 2009;117:137–47.
21. Singh MK, Kumar A, Nag S. Giant fibroadenoma of breast mimicking phyllodes tumor in an adolescent girl: Case report. IOSR Journal of Dental and Medical Sciences 2014;13(12):32-4.
22. Singh SK, Kunal, Nag S. A giant juvenile fibroaddenoma of breast. IOSR Journal of Dental and Medical Sciences 2015;14(7):1-2.
23. Robinson IA, McKee G, Nicholson A, D’Arey J, Jackson PA, Cook MG, et al.
Prognostic value of cytological grading of fine-needle aspirates from breast
carcinomas. Lancet 1994; 343:947-9.
24. Khan N, Afroz N, Rana F, Khan MA. Role of cytologic grading in prognostication of invasive breast carcinoma. J Cytol 2009;26:65-8.
25. Peacock JL, Peacock PJ. Oxford handbook of medical statistics. United States:Oxford University Press; 2011.
26. Jindal U, Singh K, Kochhar A. Fine Needle Aspiration Cytology Of Breast Lumps
With Histopathological Correlation: A Four Year And Eight Months Study From
Rural India. The Internet Journal of Pathology 2012;13(3):1-5.
27. Choi YD, Choi YH, Lee JH, Nam JH, Juhng SW, Choi C. Analysis of fine needle
aspiration cytology of the breast. Acta Cytol. 2004;48(6):801-6.
Published
2019-06-28
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