Yoshioka Haruhiko, Ueno Hiroki, Oikawa Souta, Tanaka Masanori, Hasegawa Yoshie, Horie Kayo, Watanabe Jun
Department of Bioscience and Laboratory Medicine, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan.
Yamagata Prefectural Central Hospital, Yamagata, Japan.
J Cytol. 2019 Jan-Mar;36(1):53-58. doi: 10.4103/JOC.JOC_135_17.
The objective of this study was to apply a scoring method to fine needle aspiration cytology on breast duct dilatation and cystic lesions, to set an optimum cut-off value to differentiate between benign and malignant cases, and to identify features useful for cell judgment.
Samples were 23 preparations of specimens (12 benign and 11 malignant cases) suspected with intraductal lesions or cystic change by ultrasonography or mammography and cytology. The scoring system comprised the following 10 items, and each item was scored 1-3, with a total score of 10-30. Three items were concerning structural atypia: 1, scattered epithelial cells; 2, uneven irregular cluster edge; and 3, overlapping nuclei of epithelial cells, and seven items were concerning cellular atypia: 4, irregular nuclear size; 5, irregular nuclear morphology; 6, deep dyeing chromatin; 7, chromatin granularity; 8, chromatin distribution; 9, nucleolus; and 10, absence of myoepithelial cells.
(1) Scoring cut-off value: malignancy is to be suspected when the score is 20.75 or higher (diagnostic accuracy: 95.7%). (2) Findings useful for cancer judgment: the sensitivity of the following four findings was high: uneven irregular cluster edge, irregular nuclear overlapping, chromatin granularity, and absence of myoepithelial cells. (3) Correlation among the findings: the findings correlated with malignancy were as follows: scattered epithelial cells versus uneven irregular cluster edge (rs = 0.8).
Cytological evaluation by scoring lesions accompanied by intraductal dilatation and cystic change was a useful method capable of differentiating between benign and malignant cases at a high accuracy.
本研究的目的是将一种评分方法应用于乳腺导管扩张和囊性病变的细针穿刺细胞学检查，设定一个最佳临界值以区分良性和恶性病例，并识别有助于细胞判断的特征。
样本为23份经超声或乳腺X线摄影及细胞学检查怀疑有导管内病变或囊性改变的标本制备物（12例良性和11例恶性病例）。评分系统包括以下10项，每项评分为1 - 3分，总分10 - 30分。三项涉及结构异型性：1. 散在的上皮细胞；2. 不均匀不规则簇边缘；3. 上皮细胞核重叠；七项涉及细胞异型性：4. 核大小不规则；5. 核形态不规则；6. 染色质深染；7. 染色质颗粒度；8. 染色质分布；9. 核仁；10. 肌上皮细胞缺失。
（1）评分临界值：当评分≥20.75时怀疑为恶性（诊断准确率：95.7%）。（2）有助于癌症判断的发现：以下四项发现的敏感性较高：不均匀不规则簇边缘、核不规则重叠、染色质颗粒度和肌上皮细胞缺失。（3）各项发现之间的相关性：与恶性相关的发现如下：散在的上皮细胞与不均匀不规则簇边缘（rs = 0.8）。
通过对伴有导管内扩张和囊性改变的病变进行评分的细胞学评估是一种能够高精度区分良性和恶性病例的有用方法。
