Al-Maghraby Hatem, Ghorab Zeina, Khalbuss Walid, Wong John, Silverman Jan F, Saad Reda S
Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada.
Diagn Cytopathol. 2012 Feb;40(2):141-7. doi: 10.1002/dc.21534. Epub 2010 Dec 8.
Fine-needle aspiration (FNA) biopsy (FNAB) in the preoperative assessment of breast lesions has shown diagnostic limitations with false-positive and false-negative diagnoses. We investigated the diagnostic value of cytokeratin 5/6 (CK5/6) and p63 in a series of breast FNABs, diagnosed as proliferative breast lesions with or without atypia, to see whether these ancillary studies enhance the ability to make an accurate diagnosis by FNAB. Sixty-four breast FNABs were retrieved between January 2000 and December 2005 and included in the study as follows: 29/64 (45%) cases as proliferative with atypia and 35/64 (55%) without atypia. We also included 10 cases of fibroadenoma. All cases had histological follow-up available for correlation. Immunostaining for CK5/6 and p63 was performed on the cell block material in all cases. The percentage of staining cells in the specimen was graded as 0 (0-10%), 1 (11-25%), 2 (26-50%), and 3 (>50%). There were 9/29 (31%) cases in the atypical group that were found to be malignant on resection, compared with 6/35 (17%) in the cases without atypia. In histologically proven malignant cases, CK5/6 was negative in 11/15 (73%) or showed 1+ stain in 2/15 (13%) cases. In benign breast lesions, CK5/6 stained more than 25% of cell proliferation in 44/49 (90%). p63 showed characteristic staining for single naked bipolar nuclei in the background of the specimen (not appreciated by CK5/6) in all fibroadenoma cases. In conclusion, CK5/6 may enhance the ability to differentiate between benign and malignant epithelial proliferations in breast FNABs. In fibroepithelial lesions, p63 may be more useful than CK5/6.
细针穿刺（FNA）活检（FNAB）在乳腺病变的术前评估中已显示出诊断局限性，存在假阳性和假阴性诊断。我们研究了细胞角蛋白5/6（CK5/6）和p63在一系列乳腺FNAB中的诊断价值，这些FNAB被诊断为有或无非典型性的增生性乳腺病变，以观察这些辅助检查是否能提高FNAB做出准确诊断的能力。2000年1月至2005年12月期间检索到64例乳腺FNAB，并按如下方式纳入研究：29/64（45%）例为有非典型性的增生性病变，35/64（55%）例为无非典型性的增生性病变。我们还纳入了10例纤维腺瘤病例。所有病例均有组织学随访结果可供对照。对所有病例的细胞块材料进行CK5/6和p63免疫染色。标本中染色细胞的百分比分为0（0 - 10%）、1（11 - 25%）、2（26 - 50%）和3（>50%）级。非典型性组中有9/29（31%）例在切除后被发现为恶性，而无非典型性的病例中有6/35（17%）例。在组织学证实为恶性的病例中，CK5/6在11/15（73%）例中为阴性，或在2/15（13%）例中显示1+染色。在良性乳腺病变中，44/49（90%）例中CK5/6染色超过25%的细胞增殖。在所有纤维腺瘤病例中，p63在标本背景中显示单个裸核双极的特征性染色（CK5/6未显示）。总之，CK5/6可能增强乳腺FNAB中鉴别良性和恶性上皮增生的能力。在纤维上皮病变中，p63可能比CK5/6更有用。
