Cangiarella Joan, Waisman Jerry, Simsir Aylin
Division of Cytopathology, Department of Pathology, New York University Medical Center, 530 First Avenue, Skirball, West Tower, Suite 10U, New York, New York 10016, USA.
Acta Cytol. 2003 Nov-Dec;47(6):965-72. doi: 10.1159/000326669.
To review the cytologic and subsequent histologic findings in intraductal mammary adenocarcinoma (ductal adenocarcinoma in situ) (DCIS) to evaluate the role of aspiration biopsy (AB) in identifying and grading the disease.
AB smears and tissue sections from 43 women with pure DCIS who underwent preoperative AB were reviewed. Smears were assessed for cellularity, cellular arrangement (including dissociation, nuclear size and pleomorphism), and presence of nucleoli and necrosis.
Of the 43 cases, 22 were high grade (HG) DCIS, 7 cases were intermediate grade (IG), and 14 cases were low grade (LG). Cytologic findings of HG DCIS was as follows: high cellularity (22/22), clusters of pleomorphic cells with large nuclei and increased nuclear/cytoplasmic ratios (22/22), single cells (20/22), prominent nucleoli (22/22) and necrosis (diffuse in 15/22, focal in 7/22). All LG cases had moderately to highly cellular smears with cohesive, 3-dimensional sheets of uniform, small cells with inconspicuous nucleoli arranged around a central lumen, forming "punched-out" spaces. Single cells were prominent in 2 of 14 cases. IG DCIS showed intermediate features between LG and HG DCIS: 3-dimensional sheets with punched-out spaces, abundant single cells, moderate pleomorphism and focal necrosis.
HG DCIS is easily identifiable on AB smears; however, distinction from invasive carcinoma may not be possible. The cytologic diagnosis of LG DCIS is difficult, and 50% of our cases were called atypical on AB. Recognition of cohesive cellular arrangements with crowding and punched-out spaces is crucial as single cells and prominent atypia are often lacking.
回顾乳腺导管内腺癌（原位导管腺癌，DCIS）的细胞学及后续组织学检查结果，以评估细针穿刺活检（AB）在该疾病诊断及分级中的作用。
回顾43例接受术前AB检查的纯DCIS女性患者的AB涂片及组织切片。对涂片进行细胞量、细胞排列（包括细胞解离、核大小及多形性）以及核仁与坏死情况的评估。
43例患者中，22例为高级别（HG）DCIS，7例为中级别（IG），14例为低级别（LG）。HG DCIS的细胞学表现如下：细胞量多（22/22），核大、核质比增加的多形性细胞簇（22/22），单个细胞（20/22），明显核仁（22/22），坏死（弥漫性15/22，局灶性7/22）。所有LG病例涂片细胞量为中度至高，细胞黏附，呈三维均匀小细胞片，围绕中央腔排列，核仁不明显，形成“筛状”间隙。14例中有2例单个细胞突出。IG DCIS表现出介于LG和HG DCIS之间的特征：有筛状间隙的三维细胞片、大量单个细胞、中度多形性及局灶性坏死。
HG DCIS在AB涂片上易于识别；然而，与浸润性癌可能无法区分。LG DCIS的细胞学诊断困难，我们的病例中有50%在AB检查时被判定为非典型。识别细胞黏附排列伴拥挤及筛状间隙至关重要，因为通常缺乏单个细胞及明显异型性。
