Lim Jennifer C, Al-Masri Hytham, Salhadar Alia, Xie H Bill, Gabram Sheryl, Wojcik Eva M
Department of Pathology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Diagn Cytopathol. 2004 Nov;31(5):285-8. doi: 10.1002/dc.20123.
The diagnosis of atypia in breast fine-needle aspiration (FNA) continues to be an area of debate in cytology practice. The aim of this study was to assess the clinical significance of this term and to evaluate potential morphological criteria, which would determine the patient's outcome. A computer-based search was carried out to retrieve breast FNAs performed between 1990 and 2000 that were diagnosed as atypical. Cases followed by surgical resection were reexamined for the presence of morphological features potentially differentiating benign and malignant lesions. Out of 1,568 breast FNAs, there were 64 cases (4%) with a diagnosis of atypia. Thirty-eight cases had surgical follow-up material that revealed malignancy in 14 cases (37%) and benign lesions in 24 cases (63%). The benign diagnostic categories included fibrocystic change (12/24), fibroadenoma (3/24), tubular adenoma (2/24), and nonspecific findings (7/24). The malignant diagnoses included ductal carcinoma (9/14), lobular carcinoma (3/14), ductal carcinoma in situ (DCIS; 1/14), and tubular carcinoma (1/14). The evaluation of cytological criteria used to differentiate benign from malignant lesions (i.e., cellularity, loss of cohesion, myoepithelial cells, nuclear enlargement, nuclear overlap, prominent nucleoli) revealed significant overlap between benign and malignant cases, particularly in cases of fibroadenoma, tubular adenoma, and proliferative breast disease. The surgical follow-up of four hypocellular cases revealed lobular carcinoma in two cases and ductal carcinoma in the remaining two cases. Our study confirmed that the diagnosis of atypia is clinically significant because it is associated with a high probability of malignancy. No morphological criterion is able to reliably differentiate benign and malignant lesions in cases diagnosed with atypia. Diagnosis of atypia is particularly significant in hypocellular cases. We recommended that breast FNAs with a diagnosis of atypia be evaluated further histologically.
乳腺细针穿刺活检（FNA）中不典型增生的诊断在细胞学实践中仍是一个存在争议的领域。本研究的目的是评估这一术语的临床意义，并评估可能决定患者预后的潜在形态学标准。通过计算机检索1990年至2000年间诊断为不典型增生的乳腺FNA病例。对接受手术切除的病例重新检查，以寻找可能区分良性和恶性病变的形态学特征。在1568例乳腺FNA病例中，有64例（4%）诊断为不典型增生。38例有手术随访资料，其中14例（37%）为恶性病变，24例（63%）为良性病变。良性诊断类别包括纤维囊性变（12/24）、纤维腺瘤（3/24）、管状腺瘤（2/24）和非特异性表现（7/24）。恶性诊断包括导管癌（9/14）、小叶癌（3/14）、导管原位癌（DCIS；1/14）和管状癌（1/14）。对用于区分良性和恶性病变的细胞学标准（即细胞密度、细胞黏附丧失、肌上皮细胞、核增大、核重叠、核仁明显）的评估显示，良性和恶性病例之间存在显著重叠，特别是在纤维腺瘤、管状腺瘤和增生性乳腺疾病病例中。4例细胞密度低的病例手术随访发现，2例为小叶癌，其余2例为导管癌。我们的研究证实，不典型增生的诊断具有临床意义，因为它与恶性肿瘤的高概率相关。在诊断为不典型增生的病例中，没有形态学标准能够可靠地区分良性和恶性病变。不典型增生的诊断在细胞密度低的病例中尤为重要。我们建议对诊断为不典型增生的乳腺FNA进行进一步的组织学评估。
