Davey D D, Banks E R, Jennings D, Powell D E
Department of Pathology, University of Kentucky Medical Center, Lexington 40536-0093.
Am J Clin Pathol. 1993 Jun;99(6):708-13. doi: 10.1093/ajcp/99.6.708.
Histologic grading of breast carcinomas is an important prognostic indicator of survival. An increasing number of patients, however, receive definitive therapy based on a fine-needle aspiration cytologic (FNA) diagnosis. This may limit standard grading techniques. Nuclear grade and DNA image cytometry in 35 FNA specimens taken from 34 patients were compared to DNA flow cytometry and histologic grade of the excised carcinoma using the Bloom system, as modified by Elston. Seven histologic grade I, 14 grade II, and 14 grade III infiltrating ductal carcinomas were studied. All histologic grade I carcinomas were diploid on the FNA specimen, and six showed nuclear grade 1. Twenty-seven of 28 histologic grade II and III cancers had nuclear grades of 2 or 3. Twenty-five showed aneuploidy (19 cancers) or tetraploidy (6 cancers). The other three showed diploidy with increased S/G2M (17-20%). Most of the tetraploid tumors were histologic grade II. Interobserver variability was greatest for nuclear grade (31%). Concordance between DNA studies by image analysis on the FNA and flow cytometry on the excised specimen was 80%. Both nuclear grade and DNA cytometry on FNAs can be used to distinguish most histologic grade I carcinomas from grade II and III cancers. DNA cytometry is more time-intensive but is less influenced by interobserver variation, and usually correlates with DNA flow cytometry on the excised specimen.
乳腺癌的组织学分级是生存的一项重要预后指标。然而，越来越多的患者基于细针穿刺细胞学（FNA）诊断接受确定性治疗。这可能会限制标准分级技术。将34例患者的35份FNA标本中的核分级和DNA图像细胞术与采用经埃尔斯特修改的布卢姆系统对切除癌进行的DNA流式细胞术及组织学分级进行比较。研究了7例组织学I级、14例II级和14例III级浸润性导管癌。所有组织学I级癌在FNA标本上均为二倍体，6例显示核分级为1级。28例组织学II级和III级癌中有27例核分级为2级或3级。25例显示非整倍体（19例癌）或四倍体（6例癌）。另外3例显示二倍体且S/G2M增加（17 - 20%）。大多数四倍体肿瘤为组织学II级。核分级的观察者间变异性最大（31%）。FNA图像分析的DNA研究与切除标本的流式细胞术之间的一致性为80%。FNA上的核分级和DNA细胞术均可用于区分大多数组织学I级癌与II级和III级癌。DNA细胞术耗时更长，但受观察者间变异的影响较小，且通常与切除标本的DNA流式细胞术相关。
