BREAST CYTOPATHOLOGY

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160 6. Breast Ductal LavageFigure 6.9. A cluster of markedly atypical ductal cells, with morethan three cell layers, crowded and enlarged nuclei, nuclear hyperchromasia,and nucleoli. (Thin Prep®, Papanicolaou.)Figure 6.10. A dyshesive cluster of markedly atypical ductal cellswith apocrine morphology. Anisonucleosis, nuclear hyperchromasia,and irregular nuclei are noted. (Thin Prep®, Papanicolaou.)
Breast Ductal Lavage 161two cell layers are found in half of the cases. These cells showdisorderly arrangement, moderate to marked nuclear enlargement,with high nuclear to cytoplasm ratio, nuclear overlapand anisonucleosis, irregular nuclear membrane, and coarsechromatin. Multinucleated cells and mitoses can also bepresent. Calcifications occur in about half of cases withmarked atypia, but necrotic debris is rare.Neoplastic cells in DL specimens show the characteristicfeatures of malignancy. In our experience, the number ofmalignant cells is also a determinant in rendering a definitivediagnosis of malignancy.Ljung and collaborators speculate that the diagnostic categoryof “mild atypia” encompasses the spectrum of changesof usual ductal hyperplasia and atypical ductal hyperplasia,whereas “marked atypia” corresponds to a spectrum ofchanges from atypical ductal hyperplasia to ductal carcinomain situ. However, information from clinical follow-up studiesis required and not yet available to support (or disprove) thisstatement.Reproducibility in diagnosis of DL samples in time andamong different observers is a requisite for clinical applicationof the technique. High agreement (kappa >0.70) amongtwo reviewers from the same laboratory was reported forcharacteristics of nuclear size, anisonucleosis, nucleoli,mitoses, and necrosis. In another study, interobserver agreementamong three reviewers from different laboratories wasfair to good (kappas 0.6, 0.5, and 0.48), and mild atypia wasthe least reproducible diagnosis. Johnson-Maddux and colleagueshave reported low reproducibility in the diagnosis ofmild atypia in DL samples obtained from the same patientafter a 6-month interval and have hypothesized that mildatypia might not be a correlate of epithelial dysplasia, butrather of hormonal status.The findings in DL samples obtained from women undergoingmastectomy for carcinoma have been correlated withthe histologic findings in the paired mastectomy specimen.In one study, dye injection through the microcatheter wasused to identify the duct sampled by DL. Ducts involved by
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Breast Cytopathology
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Syed Z. Ali, MDDepartment of Pathol
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To my parentsGul Bano (late) and Ma
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viiiForewordthis volume to rejuvena
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xSeries Prefaceand form the framewo
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xiiPrefacecarefully selected high-r
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ContentsForeword by Dorothy L. Rose
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2 1. Introduction and Technical Asp
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10 1. Introduction and Technical As
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2Non-neoplastic andProliferative Le
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18 2. Non-neoplastic and Proliferat
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Figure 2.26. Lactational change. Hy
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58 3. Benign and Borderline TumorsC
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60 3. Benign and Borderline TumorsF
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68 3. Benign and Borderline Tumors
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84 3. Benign and Borderline TumorsG
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86 4. Primary Malignant Tumors• M
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88 4. Primary Malignant TumorsFigur
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92 4. Primary Malignant TumorsHisto
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100 4. Primary Malignant TumorsFigu
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102 4. Primary Malignant TumorsFigu
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104 4. Primary Malignant Tumors•
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Page 152 and 153: 5Metastatic and SecondaryTumorsMeta
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Page 176 and 177: 162 6. Breast Ductal Lavagecarcinom
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Page 180 and 181: 166 IndexApocrine carcinomain axill
Page 182 and 183: 168 IndexDuctal carcinoma (cont.)fi
Page 184 and 185: 170 IndexFine-needle aspiration, of
Page 186 and 187: 172 IndexLung cancer, 138metastatic
Page 188 and 189: 174 IndexPapilloma (cont.)invasive
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BREAST CYTOPATHOLOGY

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