Atypical aspirates of the breast: a dilemma in current cytology practice.
Atypical aspirates of the breast: a dilemma in current cytology practice.
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非典型乳房抽吸：当前细胞学实践中的困境。
DOI：
10.1136/jclinpath-2016-204138
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Gary M Tse
中科院分区：
文献类型：
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作者：
Shuang-Ni Yu;Joshua Li;Sio-In Wong;Julia Y S Tsang;Yun-Bi Ni;Jie Chen;Gary M Tse
目标：概率方法被广泛用于乳腺细针穿刺细胞学检查。然而，对于C3（乳腺癌）病例，并不总是能够进行明确的细胞学诊断，这造成了管理上的困境，因为这代表了良性和恶性病例的混合类别。这将是有益的，能够预测恶性肿瘤的基础上特定的细胞学特征在C3抽吸…方法：在一个大的队列C3乳腺抽吸物与随后的组织学切除的细胞学特征（包括定量，细胞形态学和背景特征）的综合面板进行了评估，以确定相关的形态学标准预测随后的恶性肿瘤的风险。结果：共纳入了229例接受组织学随访的C3标本。30.1%的标本发生恶性结果，大多数为浸润性癌。显示与恶性结果显著相关的特征包括年龄较大（p=0.001），上皮细胞簇百分比较低，单细胞百分比较高（p=0.002），细胞簇中的筛状结构（p=0.034），存在细胞内粘蛋白（p=0.027），不含肌上皮细胞的细胞簇增加（p=0.048）、纤维粘液样基质碎片减少（p=0.001）、双极核减少（p=0.021）和存在坏死（p=0.023）。除了单细胞和细胞簇的百分比没有肌上皮细胞，所有其他特征都被证明是独立的风险预测因子在多变量分析。结论：C3抽吸物与组织学恶性肿瘤的显著概率相关。某些定量、细胞形态学和背景特征可能有助于预测恶性结局的风险。该预测在临床上可用于C3病例的管理。
AIMS: ..The probabilistic approach is widely adopted for breast fine needle aspiration cytology. However, a definite cytological diagnosis is not always possible for C3 (atypia) cases, which poses a management dilemma as this represents a mixed category of benign and malignant cases. It would be beneficial to be able to predict malignancy based on specific cytological features in C3 aspirates...METHODS: ..A comprehensive panel of cytological features (including quantitative, cytomorphological and background features) in a large cohort of C3 breast aspirates with subsequent histological excisions was evaluated to identify relevant morphological criteria predicting the risk of subsequent malignancy...RESULTS: ..A total of 229 C3 specimens with histological follow-up were included. Malignant outcome was found in 30.1% of specimens and the majority were invasive cancers. Features that showed a significant association with malignant outcome included older age (p=0.001), lower percentage of epithelial cell clusters and high percentage of single cells (p=0.002), cribriform architecture in cell clusters (p=0.034), presence of intracellular mucin (p=0.027), increased cell clusters without myoepithelial cells (p=0.048), diminished fibromyxoid stromal fragments (p=0.001), reduced bipolar nuclei (p=0.021) and the presence of necrosis (p=0.023). Except for the percentages of single cells and cell clusters without myoepithelial cells, all other features were shown to be independent risk predictors in multivariate analysis...CONCLUSIONS: ..C3 aspirates were associated with a significant probability of histological malignancy. Certain quantitative, cytomorphological and background features were potentially helpful in predicting the risk of a malignant outcome. The prediction could be clinically useful in the management of C3 cases..