BREAST CYTOPATHOLOGY

Technical Aspects 7
Pitfalls in the diagnosis of breast lesions can result from
poor preparation, inadequately sampled lesions, or lack of
communication between the person who aspirates the lesion
and the one who interprets the cytology. Some of the limitations
of this procedure include the inability to distinguish in
situ from invasive carcinoma, the need to evaluate further by
tissue biopsy, all atypical gray zone lesions, and the lack of
specific cytologic diagnoses for the majority of benign
lesions.
All cytology reports should contain a statement of adequacy.
This is true for the breast as well. The phrases “unsatisfactory
for interpretation,” “negative for malignant cells,”
“atypical/indeterminate,” “suspicious for malignancy,” and
“positive for malignant cells” describe the categories often
used with added statements explaining further findings.
“Unsatisfactory” is used for various reasons: poor technique,
obscuring blood or inflammation, paucicellular material,
and so forth. We do not encourage the use of microscopic
descriptions when a specimen is unsatisfactory for interpretation.
This could lead to misunderstanding on the part of the
clinician reading the report. Benign is used for neoplastic
as well as non-neoplastic conditions. For example: Negative
for malignant cells: mastitis. Or, negative for malignant cells:
fibroadenoma.
“Atypical cells present/indeterminate” indicates that the
specimen is abnormal but cannot be further defined. This
usually leads to additional diagnostic procedures. “Suspicious
for malignant cells” is used when the suspicion of malignancy
is great but perfect criteria are lacking; there may be few cells
present or obscuring material. The type of malignancy suspected
should be stated, that is, ductal carcinoma, sarcoma,
and so forth. This category is considered positive for quality
assurance and review purposes. “Positive for malignant cells”
is used when malignancy is certain. Again, the type of malignancy
present should be clearly stated.