Atypical Ductal Epithelial Cells in Nipple Discharge: A Cyto-Histologic Correlation from a Series of 169 Cases
K Watts, S Dolar, D Sabo, J Shorie, D Weber, B Papouchado. Cleveland Clinic, Cleveland
Background: Nipple discharge is commonly associated with benign breast lesions; however, approximately 11% of cases are caused by malignancy. Cytological examination provides a quick and non-invasive method to evaluate patients with nipple discharge. The purpose of this study was to analyze our experience with atypical ductal epithelial cells (ADEC) in nipple discharge specimens in the diagnosis of benign and malignant breast lesions.
Design: Nipple discharge smears performed at our institution between 1990 and 2008 were retrieved from the archives of Cytopathology. Cytology findings were categorized as mildly ADEC, moderately ADEC, and severely ADEC suspicious for malignancy. The presence of blood was recorded on smears with mild or moderate ADEC. Follow-up in the form of surgical pathology was evaluated in all cases.
Results: 287 smears (16%) in a series of 1825 nipple discharge specimens contained ADEC over the last 18 years. Histological correlation was available in 169 cases (59%). The patients' ages ranged from 18 to 95 years old (mean age: 54) and 167 were females. Mildly ADEC were seen in 54 cases (32%), moderately ADEC in 99 cases (59%), and severely ADEC suspicious for malignancy in 16 cases (9%). Overall, of the total 169 nipple discharge specimens with ADEC, 121 cases (72%) had benign breast conditions (papilloma or fibrocystic change [FCC]) and 48 cases (28%) had carcinoma (in-situ or invasive). Of the 54 cases with mildly ADEC, 42 had benign lesions (78%; 29 papilloma, 13 FCC) and 12 had carcinoma (22%; 9 in-situ, 3 invasive). Of the 99 cases with moderately ADEC, 71 showed benign conditions (72%; 43 papilloma, 28 FCC) and 28 had carcinoma (28%; 19 in-situ, 9 invasive). Finally, of the 16 cases with severely ADEC suspicious for malignancy, 8 showed benign lesions (50%; 4 papilloma, 4 FCC) and 8 had carcinoma (50%; 4 in-situ, 4 invasive). The two male patients had papilloma and gynecomastia. A bloody background was noted in 2 smears with mildly ADEC (both had in-situ carcinoma) and 17 smears with moderately ADEC (10 had papilloma or FCC and 7 in-situ carcinoma).
Conclusions: Our experience revealed a papilloma or FCC rate of 72% and a carcinoma rate of 28% when ADEC are seen on nipple discharge smears. Our study shows that even when the atypia is considered mild, the rate of having a carcinoma is significant. Our study also shows that the presence of blood is associated with an increased rate of malignancy since 9 of 19 cases with mild/moderate ADEC and blood had a carcinoma (47%).
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 67, Wednesday Afternoon