Mammary lesions diagnosed as “papillary” by aspiration biopsy

Simsir, Aylin; Waisman, Jerry; Thorner, Kim; Cangiarella, Joan

doi:10.1002/cncr.11062

Cited by 65 publications

(80 citation statements)

References 28 publications

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“…These morphological features can help distinguish papilloma from fibroadenoma. This is in agreement with the findings of Simsir et al [23], who evaluated the cytological features associated with papillary and non-papillary proliferations.…”

Section: Discussionsupporting

confidence: 82%

The Conundrum of Papillary Breast Lesions within the C3 Category

Weigner

Zardawi²,

Braye³

et al. 2015

Acta Cytologica

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Objectives: To identify features that could define papillary ductal cell proliferation within the C3 category and to subcategorise papillary lesions into benign papillomas which can be managed conservatively and atypical/malignant papillary neoplasms which require surgical intervention. Study Design: A blind microscopic rescreen of all C3 cases was conducted. The corresponding histological outcome was compared with the cytology. Statistical analysis was performed using papillary versus non-papillary outcomes and benign versus atypical/malignant papillary lesions. In addition, macropapillary lesions (papilloma and encysted papillary carcinoma) were plotted against micropapillary ductal carcinoma in situ. Results: Two hundred thirty FNA cases reported as C3 included 72 papillary neoplasms (52 benign papillomas and 20 atypical/malignant papillary lesions). Features specific to papillary lesions within C3 include macropapillary fragments, complex sheets, palisading strips, cystic background, cohesion and a decreased nuclear-to-cytoplasmic ratio. Features favouring atypical/malignant papillary lesions include decreased numbers of bare bipolar nuclei, discohesion and a non-cystic background. These features are common to most breast malignancies; however, identification of papillary features often results in a downgraded diagnosis from C5. Conclusions: This study supports the ability to reliably identify papillary ductal cell proliferation within C3. Certain features can distinguish papillary lesions from other C3 pathologies. This separation is likely to be clinically useful as papillary lesions may require a different management approach.

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Section: Discussionsupporting

confidence: 82%

The Conundrum of Papillary Breast Lesions within the C3 Category

Weigner

Zardawi²,

Braye³

et al. 2015

Acta Cytologica

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“…First, a papillary-like architecture can be seen in a number of benign and malignant nonpapillary proliferations. In their study, Simsir et al [106 ]were able to confirm the diagnosis of true papillary proliferation in only 31 of 70 FNAs diagnosed as papillary neoplasms. The cases that were misdiagnosed varied from FA to DCIS to invasive ductal carcinoma.…”

Section: Papillary Neoplasmsmentioning

confidence: 90%

“…Intraductal papillomas share many of the features of benign lesions of the breast, but their characteristic cytologic/histologic feature is the arborescent papillary growth of epithelial cells surrounding a fibrovascular core [106,107,108,109]. Despite this definition, a number of potential issues arise when dealing with a seemingly papillary proliferation on FNA.…”

Section: Papillary Neoplasmsmentioning

confidence: 99%

Indeterminate and Erroneous Fine-Needle Aspirates of Breast with Focus on the ‘True Gray Zone': A Review

2013

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Objective: To review our experience and the literature on inconclusive/erroneous fine-needle aspirates (FNAs) of breast with the focus on the ‘true gray zone'. To describe the cytology, differential diagnosis, pitfalls and limitations of common and rare lesions. Study Design: We conducted a literature search focusing on breast FNAs with statistical data of C3 and C4 categories including false-positive and false-negative cases. Similar data from 2003 to 2009 was obtained from our institution. Results: C3 and C4 categories account for 3-17% of breast FNAs. Contributing factors are technical difficulties, inexperienced pathologists interpreting FNAs of breast and overlap of cytologic features of certain benign and malignant conditions; this last, ‘true gray zone' accounts for 2% of cases. Fibroadenoma, proliferative breast lesions, gynecomastia, infiltrating and in situ low-grade adenocarcinomas and tubular, cribriform, lobular and mucinous carcinomas are the most common problematic lesions. Granular cell tumor, adenomyoepithelioma, pregnancy-related lesions, fat necrosis, inflammatory and radiation changes, adenoid cystic carcinoma, spindle-cell lesions and Phyllodes tumor are less common. Conclusion: Inconclusive/erroneous FNAs of breast due to the ‘true gray zone' are rare. Most are due to the overlapping cytologic features of some benign and malignant conditions. Practical features that may help arrive at the correct diagnoses are elucidated.

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“…A background of proteinaceous debris, apocrine metaplastic cells and histiocytes, all common in papillomas, should be helpful in this distinction. 34 Once the lesion sampled by AB is recognized as DCIS, grading becomes important. The level of interobserver agreement on various classifications of DCIS is not very high.…”

mentioning

confidence: 99%