Breast carcinoma detection in women age 35 years and younger: mammography and diagnosis by fine-needle aspiration cytology.Cancer. 1998 Jun 25; 84(3):163-8.C
Delays in breast carcinoma diagnosis may occur in young women due to a low index of suspicion. Fine-needle aspiration (FNA) is an ideal method for evaluating breast lesions in younger women. Mammographic and FNA findings, including nuclear grade, were studied to determine both the utility of FNA and the presence of unique cytologic features in women age < or = 35 years with breast carcinoma.
The cytopathology files were searched from 1984 to 1996 for FNA in women age < or = 35 years with breast carcinoma. The cytologic, mammographic, and clinical findings were reviewed in the 68 FNAs identified. A nuclear grade was assigned to each FNA.
Thirteen patients were age < 30 years and 55 were age 31-35 years (range, 22-35 years; average, 31 years). The clinical and mammographic findings were carcinoma in 45 patients (66%) and fibroadenoma/benign in 23 patients (34%). FNA diagnoses were malignant/suspicious (86%), atypical (12%), and negative (1.4%). In 23 patients with unsuspected carcinoma, the FNA diagnosed or suggested malignancy in 22 of 23 patients (96%). The cytologic findings on review were variable. Many FNAs were cellular, with enlarged nuclei and prominent nucleoli. The FNAs predominantly were nuclear Grade 2 (47%) and 3 (47%); only 4 tumors were nuclear Grade 1 (6%).
By detecting breast carcinoma in 23 patients with unsuspected carcinoma, this study demonstrates how breast FNA in young women can help avoid delays in diagnosis. The cytologic findings are striking for an increased incidence of high grade tumors.