Jayaram Gita, Elsayed Elnazir Mohamed, Yaccob Roshidah Binti
Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Acta Cytol. 2007 Jan-Feb;51(1):3-8. doi: 10.1159/000325674.
To analyze the cytologic features of nipple discharge and fine needle aspiration (FNA) cytologic smears from breast lesions reported as showing papillary features and to correlate them with histopathologic features.
The study group consisted of FNA smears and/or nipple discharge smears from 65 breast lesions diagnosed on cytology as duct papilloma, papillary lesion, fibrocystic condition, fibroadenoma, papillary neoplasm or papillary carcinoma. Cytomorphologic features assessed included cellularity, cell pattern (clusters, papillary, 3-dimensionality, etc.) and cell characteristics (monomorphism, pleomorphism, apocrine change, plasmacytoid features). Histological material was available for review and cytohistologic correlation in all cases.
Forty-six specimens were FNA smears, and 16 were nipple discharge smears; in 3 cases FNA and nipple discharge cytologic smears were available for review. Cytologic study could predict the presence of a papillary pattern in all neoplasms with pure or focal papillary differentiation. There was an overlap in cytomorphologic features between papillary and nonpapillary benign lesions as well as between benign and malignant papillary neoplasms. Frank blood in the aspirate, cell dissociation and atypia, however, were more frequent in the last.
Overlap of cytologic features in nonneoplastic and neoplastic benign papillary lesions and between benign and malignant papillary neoplasms necessitates histologic evaluation in all cases diagnosed as papillary on cytology. Since 49.2% of lesions showing papillary features on cytology prove to be malignant, all cases reported as papillary on cytology should be excised urgently for histologic assessment.
分析报告显示具有乳头样特征的乳腺病变乳头溢液及细针穿刺（FNA）细胞学涂片的细胞学特征，并将其与组织病理学特征相关联。
研究组由65例乳腺病变的FNA涂片和/或乳头溢液涂片组成，这些病变在细胞学上被诊断为导管乳头状瘤、乳头状病变、纤维囊性病变、纤维腺瘤、乳头状肿瘤或乳头状癌。评估的细胞形态学特征包括细胞密度、细胞模式（团簇、乳头样、三维结构等）和细胞特征（单形性、多形性、顶泌汗腺化生、浆细胞样特征）。所有病例均有组织学材料可供复查及进行细胞组织学相关性分析。
46份标本为FNA涂片，16份为乳头溢液涂片；3例同时有FNA和乳头溢液细胞学涂片可供复查。细胞学研究能够预测所有具有纯性或局灶性乳头样分化的肿瘤中乳头样模式的存在。乳头状和非乳头状良性病变之间以及良性和恶性乳头状肿瘤之间在细胞形态学特征上存在重叠。然而，抽吸物中出现明显血液、细胞解离和异型性在后者中更为常见。
非肿瘤性和肿瘤性良性乳头状病变之间以及良性和恶性乳头状肿瘤之间在细胞学特征上存在重叠，因此对于所有细胞学诊断为乳头状的病例都需要进行组织学评估。由于在细胞学上显示具有乳头样特征的病变中有49.2%被证明是恶性的，所有细胞学报告为乳头状的病例都应紧急切除以进行组织学评估。
