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Recognizing breast ductal carcinoma in situ on fine-needle aspiration: a diagnostic dilemma.
Diagn Cytopathol. 2013 Aug; 41(8):710-5.DC

Abstract

In this study, we evaluated cytomorphologic features of different subgroups of ductal carcinoma in situ (DCIS); we compared seven cytologic features between DCIS and invasive ductal carcinoma (IDC) aspirates to determine whether diagnosis of stromal invasion can be made based on fine-needle aspiration (FNA) findings. There were 142 cases of DCIS and 1,978 cases of IDC enrolled in our study. FNA analysis revealed 80.3% sensitivity for DCIS and 94.7% sensitivity for IDC. High and intermediate grade DCIS exhibited marked nuclear abnormality (92.1% vs. 35.7%, 30.0%; P1 < 0.001, P2 < 0.001) and necrosis (69.7% vs. 0%, 10.0%; P1 < 0.001, P2 = 0.001) in a higher percentage of cases compared to low grade DCIS and intraductal/intracystic papillary carcinoma. The rates of background macrophages (71.3% for DCIS and 21.9% for IDC, P < 0.001) and extensive necrosis (54.0% for DCIS and 16.7% for IDC, P < 0.001) were significantly higher in DCIS compared to IDC. Lymphocytes were observed in conjunction with tumor cells more frequently in IDC (81.3%) compared to DCIS (36.8%, P < 0.001). Stromal fragments associated with tumor cells were only observed in invasive lesions (11.9% micro-invasive DCIS and 52.1% IDC). Tubular structures were found exclusively in IDC (11.5%). Cytologic criteria for diagnosis of high and low grade DCIS are different. The suspicion of DCIS is raised when background macrophages and extensive necrosis are observed. Stromal invasion is suggested by FNA if lymphocytes are entwined around tumor cells or if stromal fragments associated with tumor cells or tubular structures are observed.

Authors+Show Affiliations

Department of Pathology, Cancer Institute/Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100021, People's Republic of China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23729369

Citation

Guo, Hui-Qin, et al. "Recognizing Breast Ductal Carcinoma in Situ On Fine-needle Aspiration: a Diagnostic Dilemma." Diagnostic Cytopathology, vol. 41, no. 8, 2013, pp. 710-5.
Guo HQ, Zhang ZH, Zhao H, et al. Recognizing breast ductal carcinoma in situ on fine-needle aspiration: a diagnostic dilemma. Diagn Cytopathol. 2013;41(8):710-5.
Guo, H. Q., Zhang, Z. H., Zhao, H., Zhao, L. L., & Pan, Q. J. (2013). Recognizing breast ductal carcinoma in situ on fine-needle aspiration: a diagnostic dilemma. Diagnostic Cytopathology, 41(8), 710-5. https://doi.org/10.1002/dc.23015
Guo HQ, et al. Recognizing Breast Ductal Carcinoma in Situ On Fine-needle Aspiration: a Diagnostic Dilemma. Diagn Cytopathol. 2013;41(8):710-5. PubMed PMID: 23729369.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recognizing breast ductal carcinoma in situ on fine-needle aspiration: a diagnostic dilemma. AU - Guo,Hui-Qin, AU - Zhang,Zhi-Hui, AU - Zhao,Huan, AU - Zhao,Lin-Lin, AU - Pan,Qin-Jing, Y1 - 2013/06/01/ PY - 2012/07/03/received PY - 2013/04/04/accepted PY - 2013/6/5/entrez PY - 2013/6/5/pubmed PY - 2013/10/18/medline KW - China KW - FNA KW - breast carcinoma KW - ductal carcinoma in situ SP - 710 EP - 5 JF - Diagnostic cytopathology JO - Diagn Cytopathol VL - 41 IS - 8 N2 - In this study, we evaluated cytomorphologic features of different subgroups of ductal carcinoma in situ (DCIS); we compared seven cytologic features between DCIS and invasive ductal carcinoma (IDC) aspirates to determine whether diagnosis of stromal invasion can be made based on fine-needle aspiration (FNA) findings. There were 142 cases of DCIS and 1,978 cases of IDC enrolled in our study. FNA analysis revealed 80.3% sensitivity for DCIS and 94.7% sensitivity for IDC. High and intermediate grade DCIS exhibited marked nuclear abnormality (92.1% vs. 35.7%, 30.0%; P1 < 0.001, P2 < 0.001) and necrosis (69.7% vs. 0%, 10.0%; P1 < 0.001, P2 = 0.001) in a higher percentage of cases compared to low grade DCIS and intraductal/intracystic papillary carcinoma. The rates of background macrophages (71.3% for DCIS and 21.9% for IDC, P < 0.001) and extensive necrosis (54.0% for DCIS and 16.7% for IDC, P < 0.001) were significantly higher in DCIS compared to IDC. Lymphocytes were observed in conjunction with tumor cells more frequently in IDC (81.3%) compared to DCIS (36.8%, P < 0.001). Stromal fragments associated with tumor cells were only observed in invasive lesions (11.9% micro-invasive DCIS and 52.1% IDC). Tubular structures were found exclusively in IDC (11.5%). Cytologic criteria for diagnosis of high and low grade DCIS are different. The suspicion of DCIS is raised when background macrophages and extensive necrosis are observed. Stromal invasion is suggested by FNA if lymphocytes are entwined around tumor cells or if stromal fragments associated with tumor cells or tubular structures are observed. SN - 1097-0339 UR - https://www.unboundmedicine.com/medline/citation/23729369/Recognizing_breast_ductal_carcinoma_in_situ_on_fine_needle_aspiration:_a_diagnostic_dilemma_ L2 - https://doi.org/10.1002/dc.23015 DB - PRIME DP - Unbound Medicine ER -