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The significance of the diagnosis of atypia in breast fine-needle aspiration.
Diagn Cytopathol. 2004 Nov; 31(5):285-8.DC

Abstract

The diagnosis of atypia in breast fine-needle aspiration (FNA) continues to be an area of debate in cytology practice. The aim of this study was to assess the clinical significance of this term and to evaluate potential morphological criteria, which would determine the patient's outcome. A computer-based search was carried out to retrieve breast FNAs performed between 1990 and 2000 that were diagnosed as atypical. Cases followed by surgical resection were reexamined for the presence of morphological features potentially differentiating benign and malignant lesions. Out of 1,568 breast FNAs, there were 64 cases (4%) with a diagnosis of atypia. Thirty-eight cases had surgical follow-up material that revealed malignancy in 14 cases (37%) and benign lesions in 24 cases (63%). The benign diagnostic categories included fibrocystic change (12/24), fibroadenoma (3/24), tubular adenoma (2/24), and nonspecific findings (7/24). The malignant diagnoses included ductal carcinoma (9/14), lobular carcinoma (3/14), ductal carcinoma in situ (DCIS; 1/14), and tubular carcinoma (1/14). The evaluation of cytological criteria used to differentiate benign from malignant lesions (i.e., cellularity, loss of cohesion, myoepithelial cells, nuclear enlargement, nuclear overlap, prominent nucleoli) revealed significant overlap between benign and malignant cases, particularly in cases of fibroadenoma, tubular adenoma, and proliferative breast disease. The surgical follow-up of four hypocellular cases revealed lobular carcinoma in two cases and ductal carcinoma in the remaining two cases. Our study confirmed that the diagnosis of atypia is clinically significant because it is associated with a high probability of malignancy. No morphological criterion is able to reliably differentiate benign and malignant lesions in cases diagnosed with atypia. Diagnosis of atypia is particularly significant in hypocellular cases. We recommended that breast FNAs with a diagnosis of atypia be evaluated further histologically.

Authors+Show Affiliations

Department of Pathology, Loyola University Medical Center, Maywood, Illinois 60153, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15468131

Citation

Lim, Jennifer C., et al. "The Significance of the Diagnosis of Atypia in Breast Fine-needle Aspiration." Diagnostic Cytopathology, vol. 31, no. 5, 2004, pp. 285-8.
Lim JC, Al-Masri H, Salhadar A, et al. The significance of the diagnosis of atypia in breast fine-needle aspiration. Diagn Cytopathol. 2004;31(5):285-8.
Lim, J. C., Al-Masri, H., Salhadar, A., Xie, H. B., Gabram, S., & Wojcik, E. M. (2004). The significance of the diagnosis of atypia in breast fine-needle aspiration. Diagnostic Cytopathology, 31(5), 285-8.
Lim JC, et al. The Significance of the Diagnosis of Atypia in Breast Fine-needle Aspiration. Diagn Cytopathol. 2004;31(5):285-8. PubMed PMID: 15468131.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The significance of the diagnosis of atypia in breast fine-needle aspiration. AU - Lim,Jennifer C, AU - Al-Masri,Hytham, AU - Salhadar,Alia, AU - Xie,H Bill, AU - Gabram,Sheryl, AU - Wojcik,Eva M, PY - 2004/10/7/pubmed PY - 2005/3/9/medline PY - 2004/10/7/entrez SP - 285 EP - 8 JF - Diagnostic cytopathology JO - Diagn Cytopathol VL - 31 IS - 5 N2 - The diagnosis of atypia in breast fine-needle aspiration (FNA) continues to be an area of debate in cytology practice. The aim of this study was to assess the clinical significance of this term and to evaluate potential morphological criteria, which would determine the patient's outcome. A computer-based search was carried out to retrieve breast FNAs performed between 1990 and 2000 that were diagnosed as atypical. Cases followed by surgical resection were reexamined for the presence of morphological features potentially differentiating benign and malignant lesions. Out of 1,568 breast FNAs, there were 64 cases (4%) with a diagnosis of atypia. Thirty-eight cases had surgical follow-up material that revealed malignancy in 14 cases (37%) and benign lesions in 24 cases (63%). The benign diagnostic categories included fibrocystic change (12/24), fibroadenoma (3/24), tubular adenoma (2/24), and nonspecific findings (7/24). The malignant diagnoses included ductal carcinoma (9/14), lobular carcinoma (3/14), ductal carcinoma in situ (DCIS; 1/14), and tubular carcinoma (1/14). The evaluation of cytological criteria used to differentiate benign from malignant lesions (i.e., cellularity, loss of cohesion, myoepithelial cells, nuclear enlargement, nuclear overlap, prominent nucleoli) revealed significant overlap between benign and malignant cases, particularly in cases of fibroadenoma, tubular adenoma, and proliferative breast disease. The surgical follow-up of four hypocellular cases revealed lobular carcinoma in two cases and ductal carcinoma in the remaining two cases. Our study confirmed that the diagnosis of atypia is clinically significant because it is associated with a high probability of malignancy. No morphological criterion is able to reliably differentiate benign and malignant lesions in cases diagnosed with atypia. Diagnosis of atypia is particularly significant in hypocellular cases. We recommended that breast FNAs with a diagnosis of atypia be evaluated further histologically. SN - 8755-1039 UR - https://www.unboundmedicine.com/medline/citation/15468131/The_significance_of_the_diagnosis_of_atypia_in_breast_fine_needle_aspiration_ L2 - https://doi.org/10.1002/dc.20123 DB - PRIME DP - Unbound Medicine ER -