Utility of Epithelial-Lined Fibrovascular Cores in Cell Blocks, Squamoid Change, and Hemosiderin for Distinguishing Papillomas from Other Lesions in FNA of the Breast
AD Darko, T Visnaskas, AH Fischer. University of Massachusetts Memorial Medical Center, Worcester, MA
Background: Papillomas of the breast are notoriously hard to diagnose by FNA, and there is a need for new criteria. Three previously untested criteria were evaluated for their ability to distinguish intraductal papillomas (IDP) from other lesions: hemosiderin in macrophages, a distinctive squamous metaplasia, and the presence of epithelial-lined fibrovascular cores (FVC) in cell block sections.
Design: We searched our Medical Center's database for breast FNA diagnoses with the term “papillary” or “papilloma” between 2005 and 2009. Of 122 cases we excluded nine cases categorically called positive (all confirmed on follow up) and 65 cases with no follow up. The FNA of the remaining 48 cases were blindly scored for hemosiderin in macrophages, squamoid change (defined as a cell with abundant waxy cytoplasm and perinuclear vacuoles, frequently in worrisome three dimensional groups with increased chromatin), and FVC in cell block sections.
Results: Surgical follow-up showed 28/48 (58%) cases of IDP and 20 cases that were not IDP. Hemosiderin was present in 18/28 (64%) of IDP and 10/20 (50%) cases that were not IDP (p<.49). Squamoid change was present in 18/28 (64%) of IDP compared to 8/20 (40%) of cases that were not IDP (p<.22). The presence of both squamoid change and hemosiderin was seen in 15/ 28 (54%) of IDP, but only 6/20 cases (30%) that were not IDP (p<.18). Cell blocks (all Cellienttm) were able to be made from residual material in 22/28 (79%) of IDP cases compared to 12/20 (60%) of cases that were not IDP. On review of available sections, FVC were identified in cell block sections in 16/20 (80%) of IDP cases but only in 2/12 (17%) of cases that were not IDP on follow-up (p<.0018). Of the two cases with FVC in cell blocks without IDP at follow-up, both had benign core biopsies; sampling error appears to account for the absence of an IDP. Of the 28 IDP cases, 6 cases (21%) had an associated carcinoma. Diagnoses for the 20 cases that were not IDP on follow-up showed 1 ductal carcinoma.
Conclusions: The presences of hemosiderin and squamoid change are associated with benign papillomas, but are not reliable for diagnosis. FVC's in cell blocks (CellientTM) is the best discriminator of true papillomas, sometimes allowing a definitive diagnosis.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 66, Wednesday Afternoon