Cytology Patterns in Random Aspirates from Women at High and Low Risk for Breast Cancer

Abstract

W Abstract: Proliferative breast disease is known t o be a common finding in women at risk for breast cancer. A group of 263 women defined as being at high risk for developing breast carcinoma underwent random fine-needle aspiration (FNA) of one or both breasts. In addition, a group of 30 low-risk volunteers underwent random FNA of one or both breasts. Using cytomorphologic criteria, only 29% of our high-risk group had normal (non-proliferative) cytology. Nine percent (9"/0) had apocrine metaplasia. Forty-three percent (43%) of high-risk women had proliferative breast disease with or without apocrine metaplasia and 19% had atypical hyperplasia (proliferative breast disease with atypia). In contrast, 83% of low-risk women had normal cytology, 17% had proliferative breast disease, and none had proliferative breast disease with atypia. The difference in prevalence of normal cytology, proliferative breast disease, and proliferative breast disease with atypia between women at high and low risk for developing carcinoma were all statistically significant (p < 0.01).Nine of the 263 women later developed in situ (n = 6) or invasive (n = 3) breast cancer. Eight of those 9 patients had proliferative breast disease with atypia on a prior random FNA and one had proliferative breast disease. These findings indicate that cytologic evidence of proliferative breast disease and proliferative breast disease with atypia from random FNA is more prevalent in highrisk than in low-risk women; and further that proliferative breast disease with atypia in the random needle aspirates is significantly associated with later cancer development.ine-needle aspiration (FNA) is considered to be a reli-F able diagnostic procedure in the evaluation of patients with palpable and/or mammographically detectable breast lesions (1-3). The technique is cost-effective, safe and, in experienced hands, has an encouraging level of diagnostic accuracy (4,s). Recently, FNA has been used to study and characterize cytologic material from nonpalpable breast lesions (4) as well as breast tissue in women considered at high risk for developing breast carcinoma on the basis of a positive family history ( 6 ) .In 1989 our group began a prospective study of cytologic characteristics and molecular abnormalities in a group of women at higher than normal risk for breast cancer development because of a first-degree relative with breast cancer, a prior contralateral breast cancer, or prior biopsy showing precancerous breast disease. The long term objective of our study is to identify, at a premalignant stage, those women in a high-risk population who will develop breast cancer within 5 years of initial testing. We present here the cytologic characteristics of FNAs from women at high risk as compared to those at low risk for developing breast carcinomas. Breast cancer development in those women is correlated with cytologic and epidemiologic variables.Eligible high-risk women were those without suspicious focal lesions by mammography who had a first-degree relative with breast...

Hypermethylation of theBreast Cancer–Associated Gene 1Promoter Does Not Predict Cytologic Atypia or Correlate with Surrogate End Points of Breast Cancer Risk

“…A minimum of one epithelial cell cluster with at least 10 epithelial cells was required to sufficiently determine pathology; the most atypical cell cluster was examined and scored (26,27). Cells were classified qualitatively as nonproliferative, hyperplasia, or hyperplasia with atypia (33). Cytology preparations were also given a semiquantitative index score through evaluation by the Masood cytology index (34).…”

Omega-3 and Omega-6 Fatty Acids in Blood and Breast Tissue of High-Risk Women and Association with Atypical Cytomorphology

“…A single cytopathologist, who did not have access to results from diet and tissue fatty acid measurements, scored specimens using categorical descriptions of (i) normal nonproliferative, (ii) hyperplasia, and (iii) hyperplasia with atypa. Specimens were also scored using an semiquantitative, adapted Masood cytology index (34), in which scores of 11 to 14 correspond to hyperplasia, scores of 15 to 18 hyperplasia with atypia, and 19 to 24 as suspicious for malignancy (34,35).…”

Overweight and Obese Perimenopausal and Postmenopausal Women Exhibit Increased Abnormal Mammary Epithelial Cytology

“…In subjects with prior invasive cancer or ductal carcinoma in situ, only the contralateral breast was aspirated. Slides for cytology were prepared in the laboratory of Dr. Carol Fabian (9,10,14). Morphologic assessment, Masood cytology index scores, and cell count were assigned by a single dedicated pathologist who was blinded to BMI (C.M.Z.…”