Tse G M K, Ma T K F, Lui P C W, Ng D C H, Yu A M C, Vong J S L, Niu Y, Chaiwun B, Lam W W M, Tan P H
Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong.
J Clin Pathol. 2008 Aug;61(8):945-9. doi: 10.1136/jcp.2008.057489. Epub 2008 Jun 13.
Cytological diagnosis of mammary papillary lesions is difficult.
To review the previous cytology diagnosis of 23 papillomas and 11 papillary carcinomas and specific cytological features that may assist in differentiating these entities.
The cytology preparations were reviewed for: (i) overall cellularity; (ii) epithelial cell ball devoid of fibrovascular cores; (iii) background single cells; and (iv) papillary fragments and their morphology.
The overall diagnostic accuracy was 59%, atypical rate was 24%, and the error (combined false positive and negative) rate was 17%. For overall cellularity, 6, 14 and 3 cases of papillomas, and 6, 3 and 2 cases of papillary carcinomas showed low, moderate and high cellularity, respectively. Cell balls were present in mild to moderate number in 20 papillomas and 10 papillary carcinomas. The background single cells were absent, or present in low or moderate to high numbers in 7, 10 and 6 papillomas, and 3, 3 and 5 papillary carcinomas, respectively. Papillary fragments were absent, or present in small, moderate or large quantities in 9, 4, 8 and 2 papillomas, and 6, 3, 1 and 1 papillary carcinomas, respectively. There was no demonstrable quantitative difference between papilloma and papillary carcinoma for all these parameters. Qualitatively, the cell balls and single cells showed a higher degree of atypia in papillary carcinoma, and the papillary fragments were more elaborate and slender.
Cytological diagnosis of papillary lesions shows a significant error rate with overlapping features. Cellular atypia and fragments with long and slender papillae with ramifying edges favour papillary carcinoma.
乳腺乳头状病变的细胞学诊断具有挑战性。
回顾23例乳头状瘤和11例乳头状癌的既往细胞学诊断情况以及有助于鉴别这些病变的特定细胞学特征。
对细胞学涂片进行如下评估：（i）细胞总数；（ii）无纤维血管轴心的上皮细胞球；（iii）背景单个细胞；（iv）乳头状碎片及其形态。
总体诊断准确率为59%，非典型率为24%，错误率（假阳性和假阴性合并）为17%。细胞总数方面，乳头状瘤分别有6例、14例和3例表现为细胞数量少、中等和多，乳头状癌分别有6例、3例和2例表现为细胞数量少、中等和多。20例乳头状瘤和10例乳头状癌中存在数量不等的轻度至中度细胞球。背景单个细胞在7例、10例和6例乳头状瘤中分别无、少量或中至大量存在，在3例、3例和5例乳头状癌中分别无、少量或中至大量存在。乳头状碎片在9例、4例、8例和2例乳头状瘤中分别无、少量、中等量和大量存在，在6例、3例、1例和1例乳头状癌中分别无、少量、中等量和大量存在。对于所有这些参数，乳头状瘤和乳头状癌之间没有明显的定量差异。定性方面，细胞球和单个细胞在乳头状癌中异型性更高，乳头状碎片更精细且细长。
乳头状病变的细胞学诊断存在显著错误率，特征重叠。细胞异型性以及具有分支边缘的细长乳头状碎片提示乳头状癌。
