BREAST CYTOPATHOLOGY

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14 1. Introduction and Technical AspectsIndications for image-guided fine-needle aspiration/core biopsies ofnonpalpable breast lesions.• Based on the availability of high-quality breast imaging and a physiciantrained to interpret the findings• Prior to image-guided biopsy, the following steps are indicated: A complete lesion evaluation by imaging studies A careful physical evaluation of the area of concern• Lesions for needle core biopsies include those that are highly suggestiveor suspicious for malignancy and some that have a low suspicious indexbut for which follow-up imaging is not feasible• All imaging findings should be documented and procedure report madeavailable• Imaging results and cytopathologic/histopathologic findings should beconcordant. Further work-up is needed if there is disconcordance and afollow-up recommendation made by the physician who performed thebiopsies• There should be documentation of communication among the physicianperforming the biopsy, the referring physician, and the patient• All false-positive and false negative results should undergo follow-upimage-guided needle biopsySource: Based on data presented at the 1996 National Cancer Institute–sponsored conference.Specimen adequacy for breast fine-needle aspiration (FNA).• Solid lesions No specific requirement for a minimum number of epithelial cells Aspirator assumes the responsibility of sample adequacy based on thejudgment that the FNA findings in the report are consistent with theclinical/radiographic findings Pathologist assumes the responsibility of ensuring that the cytologicmaterial/smears were interpretable and free from extensive artifacts The amount of epithelial cells (few, moderate, abundant) should bereported, as well as any other cellular elements Individual laboratories may consider specific cell count as their owncriterion. There is no national standard requiring a minimal count• Cystic lesions There are no criteria for a minimal cell count. If fluid is thin, watery,and not bloody, the fluid is examined or discarded at the aspirator’sdiscretion if the FNA completely evacuates the cyst and there is noresidual palpable mass left Any residual mass/nodule requires repeated FNA Cysts with brown/reddish fluid (if not related to trauma of the FNA)require careful evaluation or further work-upSource: Based on data presented at the 1996 National Cancer Institute–sponsored conference.
Selected ReadingSelected Reading 15al-Kaisi N: The spectrum of the “gray zone” in breast cytology. Areview of 186 cases of atypical and suspicious cytology. Acta Cytol1994, 38:898–908.Boerner S, Sneige N: Specimen adequacy and false-negative diagnosisrate in fine-needle aspirates of palpable breast masses.Cancer 1998, 84:344–348.Kanhoush R, Jorda M, Gomez-Fernandez C, Wang H, MirzabeigiM, Ghorab Z, Ganjei-Azar P: “Atypical” and “suspicious” diagnosesin breast aspiration cytology. Cancer 2004, 102:164–167.Lee WY, Wang HH: Fine-needle aspiration is limited in theclassification of benign breast diseases. Diagn Cytopathol 1998,18:56–61.Sidawy MK, Stoler MH, Frable WJ, Frost AR, Masood S, MillerTR, Silverberg SG, Sneige N, Wang HH: Interobserver variabilityin the classification of proliferative breast lesions by fine-needleaspiration: results of the Papanicolaou Society of CytopathologyStudy. Diagn Cytopathol 1998, 18:150–165.Sneige N: Fine-needle aspiration of the breast: a review of 1,995cases with emphasis on diagnostic pitfalls. Diagn Cytopathol 1993,9:106–112.Tabbara SO, Frost AR, Stoler MH, Sneige N, Sidawy MK: Changingtrends in breast fine-needle aspiration: results of the PapanicolaouSociety of Cytopathology Survey. Diagn Cytopathol 2000,22:126–130.Veneti S, Daskalopoulou D, Zervoudis S, Papasotiriou E,Ioannidou-Mouzaka L: Liquid-based cytology in breast fineneedle aspiration. Comparison with the conventional smear.Acta Cytol 2003, 47:188–192.Xie HB, Salhadar A, Haara A, Gabram S, Selvaggi SM, Wojcik EM:How stereotactic core-needle biopsy affected breast fine-needleaspiration utilization: an 11-year institutional review. Diagn Cytopathol2004, 31:106–110.Young NA, Mody DR, Davey DD: Diagnosis and subclassificationof breast carcinoma by fine-needle aspiration biopsy: results ofthe interlaboratory comparison program in non-gynecologiccytopathology. Arch Pathol Lab Med 2002, 126:1453–1457.
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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64 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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116 4. Primary Malignant TumorsPitf
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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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