Simplified nuclear grading of fine‐needle aspirates of breast carcinoma: Concordance with corresponding histologic nuclear grading and flow cytometric data

Abstract

Although histologic grading of breast carcinoma is widely practiced by most pathologists, cytologic grading of fine-needle aspirates (FNA) of this neoplasm is not commonly done. This study addresses the issue of the accuracy of a new classification system, a simplified Nuclear Grading (NG) system based on the criteria proposed by Black et al. (Surg Gynecol Obstet 1955;100:543) in FNA of breast carcinoma. We reviewed 100 cases of breast carcinoma, initially diagnosed by fine-needle aspiration biopsy (FNAB) with subsequent histologic confirmation, consisting of 94 ductal, five lobular, and one medullary carcinoma. NG of Papanicolaou's stained materials were reviewed twice independently by two pathologists and then were compared to the original histologic NG. The concordance rate with histology ranged from 80-90%. Intraobserver reproducibility was 86 and 88%, while interobserver reproducibility ranged from 84-88%. Of the 88 cases with corresponding flow cytometic (FCM) data, there were 35 diploid and 53 aneuploid cases. Fifty-nine (95%) of histologic high NG were aneuploid or diploid with high S-phase fraction (SPF), while 20 (77%) of histologic low NG were diploid with low SPF. This study confirms that nuclear grading of FNA of breast carcinoma using a simplified NG system has a high concordance with histology, has high intraobserver and interobserver reproducibility, and that this grading system correlates well with FCM analysis when tumors are simply divided based on NG as high or low grade.

Sistemas de graduação para carcinoma de mama: estudo comparativo da concordância cito-histológica

“…Várias classificações cito-prognósticas têm sido propostas, aplicáveis para preparados citológicos e histológicos [8][9][10][11][12]18,19 . Algumas classificações baseiam-se em critérios exclusivamente nucleares, enquanto outras associam aspectos arquiteturais e nucleares.…”

“…Para graduação nuclear foram utilizadas nos esfregaços três classificações citológicas que apresentam apenas critérios nucleares: sistema de Black modificado por Fisher et al 21 (BM), sistema de Black simplificado (BS) 10,12 e classificação de Hunt 9 . Essas classificações foram comparadas com o sistema de graduação nuclear de Black modificado por Fisher et al 21 , utilizado para avaliação dos cortes histológicos.…”

“…Apesar de ser método útil no diagnósti-co de carcinoma de mama, existem, ainda, poucos dados a respeito da acurácia da PAAF em estabelecer fatores prognósticos, tais como: o grau histológico e nuclear, o índice mitótico, receptores hormonais, genes de supressão tumoral/ oncogene e o conteúdo de DNA 7 . Alguns estudos têm mostrado que a graduação citológica nos esfregaços de carcinoma de mama correlaciona-se bem com a graduação histológica, sendo altamente reprodutível 7,[8][9][10][11][12][13][14][15][16] . Contudo, a graduação citológica de PAAF de mama não é rotineiramente utilizada 17 .…”

Cytologic Grading of Fine Needle Aspirates of Breast Carcinoma by Private Practice Pathologists

“…Recently a few studies showed that tumor grading of fine needle aspirates of breast carcinoma correlates well with histologic grading and is highly reproducible. 3,4,6,7,12 However, tumor grading of breast aspirates is not routinely practiced, especially by private practice pathologists. Possible explanations are the lack of truly objective criteria and the lack of participation by private practice pathologists themselves in studies performed by university-based pathologists.…”

“…3,4,6,7,12 Based on these studies, the grading system most applicable to cytology is the MB nuclear grading system, originally proposed by Fisher et al 9,10 The MB system is based solely on cytologic features-namely, nuclear pleomorphism, delicacy of chromatin strands, presence or absence of nucleoli, and number of mitotic figures. Because of these cytologic criteria, it has been shown that the MB grading system has a very high correlation with histology and is highly reproducible.…”