Sneige N, Staerkel G A
Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston.
Hum Pathol. 1994 May;25(5):485-92. doi: 10.1016/0046-8177(94)90120-1.
To determine cytomorphological characteristics of proliferative lesions of breast duct epithelium, we reviewed fine-needle aspiration (FNA) smears of 11 cribriform and micropapillary, low nuclear grade, ductal carcinomas in situ (DCIS), nine atypical ductal hyperplasias (ADH), and 10 florid or moderate ductal hyperplasias (DH) without atypia. These breast lesions presented as a palpable mass in 16 patients or were detected by diagnostic imaging in 14 patients. Cytological findings evaluated were cellularity, cell composition, architectural pattern (including presence and shape of intercellular spacing and cell characteristics of epithelial cell groups), nuclear diameter and pleomorphism, chromatin pattern, and number of single epithelial cells. Smears also were evaluated by cytological criteria only, using the scoring system of Masood et al. Based on our study's use of cytological and architectural features combined, the FNA diagnoses were as follows: of the 11 DCIS cases eight were carcinoma and three were inconclusive: proliferative epithelium (ADH v DCIS); of the nine ADH cases two were carcinoma and seven were inconclusive: proliferative epithelium (ADH v DCIS); and of the 10 DH cases four were DH, two were suspicious for carcinoma, and four were inconclusive: proliferative epithelium (DH v ADH). Using the cytological scoring system alone, of the 11 DCIS cases one was classified as carcinoma, five as ADH, and five as DH; of the nine ADH cases one was classified as carcinoma, three as ADH, and five as DH; and of the 10 DH cases four were classified as ADH and six as DH. This study shows that the application of both cytological and architectural criteria to the interpretation of FNA smears is more reliable than cytology alone in the identification of proliferative breast lesions and low-grade carcinoma. However, overlapping features between DH and ADH as well as ADH and low-grade carcinoma exist making separation of some of these lesions difficult. Aspirates of DH and ADH may display many single epithelial cells, mimicking low-grade carcinoma. However, a diagnosis of low-grade carcinoma can be made with confidence if the aspirates are cellular with many single atypical epithelial cells and lack an admixture of benign cellular elements. Architectural and cytological characteristics of proliferative duct epithelium, as evaluated in histological sections, are well represented in aspiration smears and should aid in the identification of these lesions.
为确定乳腺导管上皮增生性病变的细胞形态学特征，我们回顾了11例筛状和微乳头状、低核级原位导管癌（DCIS）、9例非典型导管增生（ADH）以及10例无 atypia的 florid或中度导管增生（DH）的细针穿刺（FNA）涂片。这些乳腺病变在16例患者中表现为可触及的肿块，或在14例患者中通过诊断性影像学检查发现。评估的细胞学发现包括细胞密度、细胞组成、结构模式（包括细胞间间距的存在和形状以及上皮细胞群的细胞特征）、核直径和多形性、染色质模式以及单个上皮细胞的数量。涂片还仅根据细胞学标准进行评估，采用Masood等人的评分系统。基于我们的研究对细胞学和结构特征的综合应用，FNA诊断如下：11例DCIS病例中，8例为癌，3例不确定：增生性上皮（ADH与DCIS）；9例ADH病例中，2例为癌，7例不确定：增生性上皮（ADH与DCIS）；10例DH病例中，4例为DH，2例可疑为癌，4例不确定：增生性上皮（DH与ADH）。仅使用细胞学评分系统时，11例DCIS病例中，1例分类为癌，5例为ADH，5例为DH；9例ADH病例中，1例分类为癌，3例为ADH，5例为DH；10例DH病例中，4例分类为ADH，6例为DH。本研究表明，在识别增生性乳腺病变和低级别癌方面，将细胞学和结构标准应用于FNA涂片的解读比单独使用细胞学更可靠。然而，DH与ADH以及ADH与低级别癌之间存在重叠特征，使得区分其中一些病变较为困难。DH和ADH的穿刺物可能显示许多单个上皮细胞，类似低级别癌。然而，如果穿刺物细胞丰富，有许多单个非典型上皮细胞且缺乏良性细胞成分的混合，则可以自信地做出低级别癌的诊断。在组织学切片中评估的增生性导管上皮的结构和细胞学特征在穿刺涂片中得到了很好的体现，应有助于识别这些病变。
