Atypia in fine needle aspirates of breast lesions

Tran, Phuoc; Lui, Pauline Po Yee; Yu, Alex M C; Vinh, P. T.; Chau, Helen H L; F., T. K.; Tan, Puay Hoon; Tse, Gary

doi:10.1136/jcp.2010.076752

Cited by 16 publications

(14 citation statements)

References 19 publications

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“…The histological outcome of C3 FNACs was reported to be 30–45% malignant and 55–70% benign, with similar figures (30.1% malignant, 69.9% benign) demonstrated in the current and our previous study 8. Some authors recommend strict use of diagnostic criteria to avoid excessive reporting of C3 11 14 16 18…”

Section: Discussionsupporting

confidence: 88%

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Atypical aspirates of the breast: a dilemma in current cytology practice

Wong

et al. 2017

J Clin Pathol

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Section: Discussionsupporting

confidence: 88%

“…The investigation of cytological criteria associated with C3 cases revealed a number of features, confirming our previous findings 8. The cellularity of the specimen is fundamental in formulating a diagnosis.…”

Section: Discussionsupporting

confidence: 86%

Atypical aspirates of the breast: a dilemma in current cytology practice

Wong

et al. 2017

J Clin Pathol

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“…In the practical setting, the C3 category is used when there is a level of diagnostic uncertainty. The number of C3 cases resulting in malignancy varies in the literature from 24.6 to 52% [19,20,21,22,23,24,25]. In this study, the overall rate of malignancy was 37.4%; however, the screening population yielded a much greater proportion of malignant outcomes at 50% when compared with the symptomatic population at 32%.…”

Section: Discussionmentioning

confidence: 61%

“…Confronting architectural patterns or cell morphological aberrations contribute to diagnostic uncertainties. These features reflect the heterogeneity of the C3 outcomes, which ranged from benign to malignant [22]. …”

Section: Discussionmentioning

confidence: 99%

The True Nature of Atypical Breast Cytology

Weigner

Zardawi²,

Braye³

2013

Acta Cytologica

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Background: Atypical breast cytology is a poorly understood heterogeneous category with limited clinical utility but significant implications for patient management. Objective: To provide an insight into the true nature of atypical breast cytology in screening-detected (asymptomatic) and symptomatic settings, and find strategies for reducing the use of this diagnostic category. Materials and Methods: A total of 6,415 breast cytology samples were processed between January 2004 and December 2008. An atypical cytological diagnosis was rendered in 256 (4%) of the cases. A blind microscopic review of the atypical cases was conducted and results were correlated with subsequent histological and/or clinical outcomes. Results: Follow-up information by histology was available in 85.5%, by repeat fine-needle aspiration (FNA) in 3.5% and by imaging or clinical follow-up in 10.2% of the cases. Two patients (0.8%) were lost to follow-up. Of the 254 cases with follow-up, 62.6% were benign and 37.4% were malignant. The benign to malignant ratios were 1:1 and 2:1 in the screening and symptomatic groups, respectively. The atypical category in the screening population mostly yielded fat necrosis, complex sclerosing lesions and low- to intermediate-grade carcinoma on follow-up. The main outcomes in the symptomatic group were papilloma, fibroadenoma, ductal carcinoma in situ and lobular carcinoma. Preanalytical (suboptimal samples) factors were encountered in 34.8% and interpretative factors in 65.2% of the cases. Uncertainty about cellular morphology was attributed to such a diagnosis in 38 (14.8%) of the cases, architectural complexity in 137 (53.5%) and morphology and architecture in 70 (27.3%); 4.3% of cases were considered nondiagnostic. Conclusion: The atypical category is a necessary diagnosis but of limited use from a patient management perspective. Some preanalytical factors such as poor sample quality can be minimized by the involvement of cytopathologists in the FNA procedure. The use of the atypical category is partly dependent on the experience and confidence of the reporting pathologist. Assigning a case to this category is also likely to be unduly influenced by clinical or radiological findings. Our study indicates that the use of the atypical category can be reduced by up to 40% by appreciating these contributing factors. The practical utilization of the atypical category in breast cytology remains subjective and further study is required to identify useful objective criteria.

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“…We, like others have shown a heterogeneous mix of pathological outcomes during the follow up of C3 (5,(9)(10)(11)(12)(13)(14). In our earlier study, of 230 atypical (C3) cases, we found 37.4% to be malignant on follow-up and the remaining 62.6% yielded benign outcomes.…”

Section: Introductionsupporting

confidence: 50%

Stratification of risk of malignancy in atypical breast fine needle aspiration: a cytomorphological approach

Weigner

Zardawi²,

Braye

et al. 2017

J Diagnostic Path

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SummaryAlthough atypical (C3) breast cytology is a legitimate reporting category, it is not very useful clinically because it yields benign as well as malignant histological outcomes. Therefore, a cytomorphological approach to minimise inappropriate use of the C3 category may improve the clinical usefulness of this category. In a previous training set of 180 atypical breast cytology (C3) cases we had identified the best discriminating cytological criteria to predict the histological outcomes (malignant, benign proliferative and benign non-proliferative). Using a selection of these previously identified statistically significant criteria (cystic background, cohesiveness, myoepithelial cells or bare bipolar nuclei, papillary fragments and tubules) we tested their ability to predict the same outcomes on 182 subsequent C3 cases (validation set). The diagnostic accuracy for each outcome was compared with the training set. A probability calculator with nominated cut-points was developed to stratify and re-grade C3 cases. Cases outside the cut-points were either up-graded to suspicious (C4) or down-graded to benign (C2). Re-graded cases were reviewed to identify reasons for over or under-interpretation. Statistical analysis showed comparable diagnostic accuracy between the training set and the validation set for malignant and benign proliferative outcomes but not for the benign non-proliferative outcome. The probability calculator resulted in an up-grade of 18% (33/182) ofthe cases. Malignant histology was seen in 25/33 (76%) of the up-graded cases but 8/33 (24%) produced a proliferative non-malignant outcome. A meaningful lower cut-point could not be established without including malignant cases. The C3 category remains a legitimate with a heterogeneous mix of pathological entities. Attempts to minimise inappropriate allocation of C3 cases into this category have met with limited success.

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Atypia in fine needle aspirates of breast lesions

Cited by 16 publications

References 19 publications

Atypical aspirates of the breast: a dilemma in current cytology practice

Atypical aspirates of the breast: a dilemma in current cytology practice

The True Nature of Atypical Breast Cytology

Stratification of risk of malignancy in atypical breast fine needle aspiration: a cytomorphological approach

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