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Fine-needle aspiration of gray zone lesions of the breast: fibroadenoma versus ductal carcinoma.
Diagn Cytopathol. 2013 Sep; 41(9):806-11.DC

Abstract

While breast lesions have characteristic cytological features, some lesions, particularly adenocarcinoma and fibroadenoma, may present with overlapping features causing erroneous diagnoses. The current study aimed to define significant cytomorphologic features predictive of fibroadenoma and adenocarcinoma, respectively. Further, we intended to evaluate the predictive characteristics for differentiation between gray zone lesions and to identify root causes contributing to misdiagnoses. First, direct smears prepared from 14 histology-confirmed fibroadenomas and 14 adenocarcinomas were reviewed and characteristics of commonly encountered morphologic features were assessed. We then retrospectively and blindly reviewed nine cytohistologic discrepant cases using the significant characteristic as a guideline, in order to assess whether these discrepant cases could be correctly categorized. Morphologic characteristics predictive of fibroadenoma included moderate cellularity, large, folded cellular sheets/aggregates, staghorn projections, smooth and round borders, monolayers, honeycomb arrangement, smaller nuclear size, and background bipolar cells. Predictive characteristics of adenocarcinoma included high cellularity, loose cohesive sheets/aggregates, pointed projections, irregular borders, larger nuclear size, irregular nuclear membrane, prominent nucleoli, and single atypical epithelial cells. Retrospective, blind review correctly re-classified seven out of nine cytohistologic discrepant cases, including five false negative cases and two false positive cases. Root causes contributing to the misdiagnoses were large branching sheets of carcinoma mimicking folded sheets of fibroadenoma; fibroblasts mimicking myoepithelial cells; apocrine cells mimicking carcinoma cells; and not recognizing the loose myxoid matrix presenting as soap bubbles in fibroadenoma. In conclusion, this study identified significant characteristics that can assist in achieving accurate diagnosis in a subpopulation of breast aspirates that present with overlapping features.

Authors+Show Affiliations

Department of Pathology, University of Michigan, Ann Arbor, Michigan.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22936545

Citation

Jing, Xin, et al. "Fine-needle Aspiration of Gray Zone Lesions of the Breast: Fibroadenoma Versus Ductal Carcinoma." Diagnostic Cytopathology, vol. 41, no. 9, 2013, pp. 806-11.
Jing X, Normolle D, Michael CW. Fine-needle aspiration of gray zone lesions of the breast: fibroadenoma versus ductal carcinoma. Diagn Cytopathol. 2013;41(9):806-11.
Jing, X., Normolle, D., & Michael, C. W. (2013). Fine-needle aspiration of gray zone lesions of the breast: fibroadenoma versus ductal carcinoma. Diagnostic Cytopathology, 41(9), 806-11. https://doi.org/10.1002/dc.22914
Jing X, Normolle D, Michael CW. Fine-needle Aspiration of Gray Zone Lesions of the Breast: Fibroadenoma Versus Ductal Carcinoma. Diagn Cytopathol. 2013;41(9):806-11. PubMed PMID: 22936545.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fine-needle aspiration of gray zone lesions of the breast: fibroadenoma versus ductal carcinoma. AU - Jing,Xin, AU - Normolle,Daniel, AU - Michael,Claire W, Y1 - 2012/08/31/ PY - 2012/03/27/received PY - 2012/05/30/revised PY - 2012/07/20/accepted PY - 2012/9/1/entrez PY - 2012/9/1/pubmed PY - 2014/3/26/medline KW - breast KW - ductal carcinoma KW - fibroadenoma KW - fine needle aspiration KW - gray zone lesions SP - 806 EP - 11 JF - Diagnostic cytopathology JO - Diagn Cytopathol VL - 41 IS - 9 N2 - While breast lesions have characteristic cytological features, some lesions, particularly adenocarcinoma and fibroadenoma, may present with overlapping features causing erroneous diagnoses. The current study aimed to define significant cytomorphologic features predictive of fibroadenoma and adenocarcinoma, respectively. Further, we intended to evaluate the predictive characteristics for differentiation between gray zone lesions and to identify root causes contributing to misdiagnoses. First, direct smears prepared from 14 histology-confirmed fibroadenomas and 14 adenocarcinomas were reviewed and characteristics of commonly encountered morphologic features were assessed. We then retrospectively and blindly reviewed nine cytohistologic discrepant cases using the significant characteristic as a guideline, in order to assess whether these discrepant cases could be correctly categorized. Morphologic characteristics predictive of fibroadenoma included moderate cellularity, large, folded cellular sheets/aggregates, staghorn projections, smooth and round borders, monolayers, honeycomb arrangement, smaller nuclear size, and background bipolar cells. Predictive characteristics of adenocarcinoma included high cellularity, loose cohesive sheets/aggregates, pointed projections, irregular borders, larger nuclear size, irregular nuclear membrane, prominent nucleoli, and single atypical epithelial cells. Retrospective, blind review correctly re-classified seven out of nine cytohistologic discrepant cases, including five false negative cases and two false positive cases. Root causes contributing to the misdiagnoses were large branching sheets of carcinoma mimicking folded sheets of fibroadenoma; fibroblasts mimicking myoepithelial cells; apocrine cells mimicking carcinoma cells; and not recognizing the loose myxoid matrix presenting as soap bubbles in fibroadenoma. In conclusion, this study identified significant characteristics that can assist in achieving accurate diagnosis in a subpopulation of breast aspirates that present with overlapping features. SN - 1097-0339 UR - https://www.unboundmedicine.com/medline/citation/22936545/Fine_needle_aspiration_of_gray_zone_lesions_of_the_breast:_fibroadenoma_versus_ductal_carcinoma_ L2 - https://doi.org/10.1002/dc.22914 DB - PRIME DP - Unbound Medicine ER -