BREAST CYTOPATHOLOGY

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8 1. Introduction and Technical AspectsClinical indications for breast fine-needle aspiration.• Diagnostic Inflammatory diseases (uncommon) Primary neoplasms (benign vs. malignant) Secondary or metastatic tumors (including hematologic/lymphoidmalignancies) Atypical epithelial lesions (require further studies) Tumor recurrence• Therapeutic Evacuation of simple/inflammatory cystsAdvantages of breast fine-needle aspiration.• Economical/cost-effective outpatient procedure• Minimally traumatic (physically and psychologically)• High acceptance rate (by clinicians and patients)• Rapid and accurate/sensitive assessment (within minutes)• Informed pretreatment planning with the patient• Sampling of tumor for biomarkers/molecular/ancillary studies• Evaluation of multiple nodules/lesions• Accurately distinguishes mastitis from inflammatory carcinoma andintramammary lymph nodes from true epithelial lesions, particularly inthe area of the tail of the breast• Avoidance of open biopsy in nonneoplastic lesions, inoperable lesions,or tumor recurrence• May offer curative relief by cyst evacuation• Accurate and rapid assessment of tumor recurrence in locally advancedcancer (particularly chest wall recurrence) for better tumor stagingMajor limitations of breast fine-needle aspiration.• Inability to reliably distinguish between in situ and invasive breastcarcinomas (all histologic subtypes)• Accuracy often dependent on the size of the lesion (less sensitive below5 mm)• Low accuracy in tumors that are predominantly cystic/necrotic,hemorrhagic, desmoplastic, or located deep in the breast• Lack of specific diagnosis for most benign lesions• Need to biopsy all lesions with atypical gray zone diagnoses
Major complications of breast fine-needle aspiration.• Bleeding/hematoma• Infection• Pneumothorax• Vasovagal reaction• Epithelial displacement/tumor seeding• Changes/artifacts occurring after aspiration may interfere with radiographic/mammographic interpretationMajor diagnostic pitfalls of breast fine-needle aspiration.• False-negative diagnoses• False-positive diagnoses Small focus of carcinoma Fibroadenomain a background of a dominant Papilloma/papillary lesionsbenign lesion (such as extensive Atypical ductal hyperplasiafibrocystic changes with apocrine Pregnancy-associated ormetaplasia)lactational changes Carcinoma arising in a complex Skin adnexal tumorsproliferative lesion (such as Other lesions (such as fatcarcinoma arising in papilloma) necrosis, collagenous Well-differentiated carcinomas spherulosis)(such as in situ carcinomas, bothductal and lobular) Specific histologic subtypes(such as tubular carcinoma,colloid carcinoma) Rare tumor types (such asmetaplastic carcinoma, apocrinecarcinoma) Extensively necrotic or cysticcarcinoma Sampling errors (in lesions thatare small, deep, or have denselyfibrotic stroma) Poorly prepared or inadequatesmearsNormal cytologic constituents in breast fine-needle aspirationsamples.• Epithelium (ductal, lobular, apocrine, squamous)• Myoepithelium• Macrophages• Endothelium• Adipose, stromal, and other mesenchymal issueNote: See Figures 1.1 through 1.6.
Page 2 and 3: Breast Cytopathology
Page 4 and 5: Syed Z. Ali, MDDepartment of Pathol
Page 6 and 7: To my parentsGul Bano (late) and Ma
Page 8 and 9: viiiForewordthis volume to rejuvena
Page 10 and 11: xSeries Prefaceand form the framewo
Page 12 and 13: xiiPrefacecarefully selected high-r
Page 14 and 15: ContentsForeword by Dorothy L. Rose
Page 16 and 17: 2 1. Introduction and Technical Asp
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Page 30 and 31: 2Non-neoplastic andProliferative Le
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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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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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116 4. Primary Malignant TumorsPitf
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120 4. Primary Malignant TumorsInfl
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134 4. Primary Malignant TumorsClin
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136 4. Primary Malignant Tumorsdiag
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5Metastatic and SecondaryTumorsMeta
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140 5. Metastatic and Secondary Tum
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Figure 5.6. Metastatic small cell c
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BFigure 5.9. (B) Metastatic papilla
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154 6. Breast Ductal LavageTable 6.
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156 6. Breast Ductal LavageFigure 6
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162 6. Breast Ductal Lavagecarcinom
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164 6. Breast Ductal LavageKrishnam
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166 IndexApocrine carcinomain axill
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168 IndexDuctal carcinoma (cont.)fi
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170 IndexFine-needle aspiration, of
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172 IndexLung cancer, 138metastatic
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174 IndexPapilloma (cont.)invasive
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BREAST CYTOPATHOLOGY

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