[391] Cytological Evaluation of "Bloody" Nipple Discharge with Histopathological Correlation: Study of 50 Cases.

Rachel E Kaplan, Syed A Hoda, Rana S Hoda. Weill Cornell Medical College, New York, NY

Background: Nipple discharge can be serous, milky, mucoid, turbid or bloody. Bloody nipple discharge (BND) is particularly alarming, and is considered most likely to be associated with a pathological (rather than physiological) cause. Data on BND cytology (BNDC) with histopathological correlation is scarce.
Design: Excisional biopsies (including micrdochectomies), 2000-to date, submitted with BND as clinical information, and in which there had been prior BNDC were identified and reviewed. Cytological evaluations were classified as Positive (Pos), Papillary (Pap), Atypical (Aty), Negative (Neg) or Unsatisfactory-Acellular (Unsat).
Results: 50 cases with 55 BNDC (5 cases with 2 specimens <8 months apart) were studied. Mean age of patients was 50 (range: 14-87). BND was unilateral in all 50 patients (right: 28, left: 22). Histopathology diagnoses were invasive carcinoma (Inv Ca): 5; ductal ca in situ (DCIS): 5; atypical hyperplasia (Aty): 2; papilloma: 16 (32%, single most common cause of BND); other benign (Oth): 22. In 4 BNDC cases, the 1st specimen was Unsat or Neg. In 1 case, both BNDC were Pap. Final cytology diagnoses were Pos: 3; Pap, 13; Aty: 4; Neg: 25; and Unsat: 5.

Bloody Nipple Discharge: Correlation of Final Cytology and Histopathology Diagnoses
 Invasive CaDCISAtypicalPapillomaOtherTotal, on Cytology
Positive101103
Papillary2204513
Atypical000224
Negative23171225
Unsatisfactory000235
Total, on Histopathology552162250


Table shows correlation of cytology and histopathology diagnoses. Cytology preps included direct smears in 51, ThinPrep in 2, and both in 2. Direct smears were stained via Pap stain (89%) or DiffQuik (11%). Significant air-drying artifact was seen in 15% (8/55) specimens. Cytology preps were Unsat in 13% (7/55) specimens. Cytology features evaluated included background, necrosis, rbc's, macrophages, cellularity, cell clusters, nuclear atypia, columnar cells and apocrine cells. 25 Neg BNDC predominantly showed rbc's and macrophages. Necrosis was present in 1 case of sclerotic papilloma. Apocrine cells were identified in 1 case of DCIS.
Conclusions: In this series, sensitivity of BNDC was 20%, specificity was 96%, accuracy was 88%, and precision was 33%. Factors most likely leading to false-negative and false-positive results in cytology were unsatisfactory smears and air-drying, respectively. Presence of necrosis and apocrine cells may be misleading. BND was more commonly associated with benign lesions in 76% (38/50) of cases in this series.
Category: Cytopathology

Wednesday, March 2, 2011 1:00 PM

Poster Session VI # 92, Wednesday Afternoon

 

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