Papillary Pattern in Breast Aspirates; Cytologic Differential Diagnosis with Histopathologic Correlation
S Selegean, J Lim, JM Cohen, M Harshan. Beth Israel Medical Center, New York, NY; Albert Einstein College of Medicine, Bronx, NY
Background: Aim of the study is to analyze the accuracy of nipple discharge/ lavage smears and fine needle aspiration (FNA) for diagnosing papillary lesions, to assess the frequency of their cytologic look-alikes and to correlate the histopathologic features.
Design: Retrospective search was done for cytologic diagnosis of papillary lesions of the breast with subsequent excisional biopsy, over a period of 4.5yrs (2004- 2008) in the database of 3 hospitals in the health system. Of the 278 cases, 165 were FNA performed with ultrasound guidance and 72 FNA without guidance and 41 ductal lavage and nipple secretion smears. Cytology diagnosis were categorized as follows: papillary lesion/ papillary neoplasm (PL/ PN), PL/ PN with atypia, fibrocystic changes with papillary features, papillary carcinoma and correlated with the final pathology on excisional biopsy.
Results: Final pathology showed benign papillomas 157 (56.4 %), papillary duct hyperplasia 4 (1.4 %), FCC 46 (16.5 %), fibroadenoma (FA) 11 (3.9 %), insitu and invasive carcinoma 34 (21.2 %). For detailed results see Table 1.
Table1:X axis - Final diagnosis, Y axis- Cytology diagnosis
|Papilloma/Papillomatosis||Papillary Duct Hyperplasia||FCC||FA||DCIS/ LCIS||IDCA/ ILCA|
|PL/PN||109/ 25||4||36||8||21/ 2||7/ 1|
|PL/PN with atypia||12/ 2||1||1||0||7/ 1||13/ 1|
|FCC with papillary features||5/ 3||0||9||3||1/ 0||0/ 0|
|PCA||1/ 0||0||0||0||2/ 0||3/ 0|
PL with atypia; showed 2 cases with papilloma and associated lobular carcinoma in situ (LCIS), 1 showed atypical duct hyperplasia and 1 gynecomastia with focal ductal hyperplasia. 3 LCIS were seen without accompanying papillomas. 11 DCIS showed associated benign papillomas, 5 showed micropapillary type DCIS, 8 intraduct cystic papillary carcinoma and 2 intraduct solid papillary carcinomas. Invasive duct carcinoma (IDCA) showed 2 colloid carcinomas of which 1 had associated benign papillomatosis. 1 invasive lobular carcinoma (ILCA) also showed associated papillomatosis.
Conclusions: Papillary lesions of breast can be reliably diagnosed by cytologic evaluation. Significant overlap of cytologic features exists between benign non papillary and benign and malignant papillary lesions. Since 21.2% of lesions showing papillary features on cytology proved to be malignant, all cases reported as papillary on cytology should have histologic assessment.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 64, Wednesday Afternoon