PAAF vs Core Biopsy en Lesiones Mamarias Case #1
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1 5/19/2014 PAAF vs Core Biopsy en Lesiones Mamarias Case #1 Fine Needle Aspiration Cytology of Breast: Correlation with Needle Core Biopsy 64-year-old woman Mass in breast Syed Hoda, MD CD31 Post-Radiation Angiosarcoma Ki67 1
2 Post-Radiation Angiosarcoma Age: 50 Interval: 6 years (r: 3-12) Target: Skin, Breast, Both Grade: Any Risk of AS: 0.1%, 1 in 1000 Park et al FNA of Post-radiation Angiosarcoma. Diagn Cytopathol 2010 E-pub Case #2 Clinical history is key 41-year-old Calcifications 2 DQ Pap 2
3 Pap Pap NCB Congo.Red Amyloid Tumor 3
4 Mammary Amyloid Tumor Rare Mass Mammographic abnormality Older women Associations: Myeloma, Rheumatoid Arthritis Cytology can be difficult APMIS. 2008;116:846-9 Mammo: dense, no discrete mass Case #3 37-year-old Lumpiness Ultrasound: Irregular hypoechoic shadowing Pap TP 4
5 TP NCB Diabetic Mastopathy B: T: CD3 CD20 Diabetic Mastopathy Tumoral Mass May be multiple, bilateral Fibrosis, Lymphocytes Insulin-dependent diabetics Age: <30, 20 years after onset Rollins SD. FNA Cytology of Diabetic Fibrous Mastopathy. Diagn Cytopathol 1993;9:687 Cytology can be very difficult Inadequate Rate for non-palpable non-calcific lesions: ~50% Review of literature thru
6 DQ Case #4 34-year-old pregnant woman Painful lump in left breast NCB Excisional biopsy CK Actin Infarcted tumor? Lactational Adenoma 6
7 Lactational adenoma Fat necrosis Typical Triple-Negative Carcinoma CT MRI Infarcted papilloma, usually benign Histology Gross Typical Triple-Negative Carcinoma CT MRI Necrosis in cytology can be benign or malignant Histology Gross 7
8 Case #5 47-year-old woman Mass in left breast DQ Pap NCB 8
9 Apocrine Metaplasia Granular Cell Tumor Histiocytes S100p+ DQ Mammary Granular Cell Tumor Simulates carcinoma: radiographically, clinically & grossly Characteristic granular cytology S100p positive Elauoni et al. Breast Granular Cell Tumor. Diagn Cytopathol 2007;35:725 Pap Case #6 Cytology can be better than Surgical Biopsy 55-year-old Ill-defined mass in right breast 9
10 Lobular Carcinoma Diagnostic Pitfalls Few cells Small cells ells Clinical findings subtle Radiology findings subtle False-negative rate: 28% Kelten et al. Cytology of Lobular Carcinoma Cytopathology 2009;20:321 10
11 Smear SP Always remember Invasive lobular carcinoma DQ TP Case #7 54-year-old Mass DQ Pap 11
12 NCB CD45 CK CD138 Plasmacytoma CD138 Mammary Plasmacytoma Rare lesion Mass Kumar et al. Breast Myeloma, 3 Cases. Acta Cytol 2005;49:445 12
13 Case #8 Remember non-breast diseases 48-year-old woman Mass in breast & axilla Pap DQ DQ Pap NCB p63 p63 13
14 p63 Pax5 p63 CD20 Primary Mammary B-Cell Lymphoma Fukishima p63 in B.cell lymphoma Cancer Sci 2006;96;1050 Primary Mammary Lymphoma <1% of Primary Breast Tumors Usually B-cell Diffuse Large B-Cell, Follicular, MALToma May Simulate Carcinoma Axillary Nodes Involved in ~50% Immunostains can mislead, in aspiration cytology & core biopsy Kuroda et al. Primary Breast Lymphoma. Breast Cancer 2007;14:317 14
15 Case #10 19-year-old 2 cm mass SZA-AVP Cytology of Fibroadenoma Hypercellular Sheets of cells in clusters Naked cells in background NCB 15
16 SZA-AVP Problems in Fibroadenoma Cytology of Fibroadenoma Challenges No clusters Minimal stroma Pleomorphism # 1 cause of false-positive Kollur et al. Cytopathol 2006 Zhao C et al, Cancer Cytopathol, 2009 Benoit JL et al, Diag Cytopath, 2002 Deshpande KM et al, Diag Cytopath, 2002 Case #11 Features of Malignancy Hypercellular One-cell population Single Cells Atypia 63-year-old Calcifications on first mammogram 16
17 TP Schistosomiasis Chen et al. Schistosoma by Cytology. Diagn Cytopathol 2007;35:722 Disadvantages of FNA of Cytology Aspiration cytology is not appropriate for calcifications Inadequate Rate for non-palpable calcific lesions: ~30% Higher non-diagnostic rate Lower negative-predictive value? proliferative lesions? in situ vs invasive ca? ancillary studies Review of literature thru
18 Advantages of FNA of Breast Minimally invasive Low morbidity Immediate assessment Sampling of multiple lesions Lower cost Reliability of Aspiration Cytology of Breast Sensitivity 65-98%, ~90% Specificity %, ~99% False-positive 0.5-2% False-negative 3-5% False-suspicious 1-13% Review of Literature thru 2014 False-Positives in Breast Cytology Causes: Sampling, Interpretation, Both Prevention: Apply Triple-Test Experience Technique Triple Test Clinical, Radiology & Cytology Match in Breast Cytology If Triple Test passed Correct diagnosis of 97% of carcinoma Correct diagnosis of 100% of benign Review of Literature thru 2014 Litigation Claims on Breast Diagnoses Breast-related: 22% of all Breast Cytology: 06% False-positive = False-negative Most common false+: Fibroadenoma Adequacy Criteria in Breast Cytology Quantitative Criteria: cells, cell type, slides, passes. 6 clusters, x5-10 cells in each Qualitative Criteria: clinical, radiological, cytological Solid lesions: Cystic lesions:? Criteria Persistent Cyst> Repeat Troxel et al. Archiv Pathol Lab Med 2006;130:617 18
19 Indications Fine Needle Aspiration in Breast Mass, core biopsy not available Cyst aspiration Recurrent tumor Axillary mass Newer Indications for Aspiration Cytology in Breast Assess chemotherapy response Assess lymph node involvement Screen BRCA patients Implant-associated effusion, lymphoma Q1 Test Carcinoma Q2 Q3 Apocrine Metaplasia Carcinoma 19
20 Q4 Q5 Fibroadenoma Carcinoma 20
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