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Reproductive System > Breast Cytology and Biopsy > Flashcards

Breast Cytology and Biopsy Flashcards

1
Q

What is cytology?

A

Microscopic examination of a thin layer of cells on a slide obtained by:

  • Fine Needle Aspiration
  • Direct smear from nipple discharge
  • Scrape of nipple with scalpel
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2
Q

What are the indications to carry out cytology for breast investigation?

A

A symtomatic clinic:

  • Pt presents with symptoms and undergoes “triple assessment” by surgeon, radiologist and cytopathologist

Breast screening:

  • Asymptomatic women invited for mammographic exam (most get core biopsy) - FNA of axillary node/satellite lesions
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3
Q

Describe the appearance of a palpablae (symptomatic) disease of the breast

A
  • Discrete mass; solid or cystic
  • Diffuse thickening
  • Nipple lesion:
    • Discharge
    • Eczematous skin
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4
Q

What equipment is required for FNA?

A
  • 23G needle
  • 10ml syringe +/- Cameco holder
  • Alcohol swab
  • Cotton wool, sticking plaster
  • Glass slides, pencil
  • +/-Vial with saline for needle washings
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5
Q

How is a FNA carried out is suspected breast tumour is impalpable?

A

Use USS-guided FNA technique

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6
Q

What are the features of a benign tumour on cytology?

A
  • Low/ moderate cellularity
  • Cohesive groups of cells
  • Flat sheets of cells
  • Bipolar nuclei in background
  • Cells of uniform size
  • Uniform chromatin pattern
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7
Q

What are the features of a malignant tumour on cytology?

A
  • High cellularity
  • Loss of cohesion
  • Crowding/overlapping of cells
  • Nuclear pleomorphism
  • Hyperchromasia
  • Absence of bipolar nuclei
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8
Q

What are two of the main malignant tumours diagnoses made from cytology?

A

Usually diagnosis non specific ieadenocarcinoma NOS

Occasionally features may suggest type:

  • Lobular carcinoma - cytoplasmic vacuoles
  • Tubular carcinoma - cells arranged in tubes
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9
Q

State the cytology scoring system

A

C1 Unsatisfactory

C2 Benign

C3 Atypia (probably benign)

C4 Suspicious (probably malignant)

C5 Malignant

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10
Q

What is the effect of FNA on cysts?

A

Curative

Fluid discarded unless:

  • Fluid is bloodstained
  • Presence of residual mass
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11
Q

What are the advantages of FNA?

A

Pros:

  • Simple procedure - can be done at clinic
  • Well tolerated by patients
  • Inexpensive
  • Immediate results
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12
Q

What are the limitations of FNA?

A

Cons:

  • False negatives and positives
  • Invasion cannot be assessed
  • Grading cannot be done
  • Sampling (lesion missed) - sample lesions or tumour in larger are of thickening
  • Difficulat to examine cells (suboptimal smears: blood, thick, cells smeared)
  • Interpretation
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13
Q

What are the complications which can arise with FNA?

A
  • Pain
  • Haematoma
  • Fainting
  • Infection, Pneumothorax –rare
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14
Q

Are there any contraindications for a FNA?

A

None

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15
Q

What is the indication to carry out a cytology for a nipple lesion?

A

Bloody discharge from signle duct

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16
Q

What conditions can be identified from cytology of nipple discharge?

A
  • Duct ectasia - macrophages only
  • Intraduct papilloma - benign cells in papillary groups
  • Intraduct carcinoma (DCIS) - malignant cells
17
Q

What conditions can be identified from cytology of a nipple scrape?

A
  • Paget’s Disease (squamous cells and malignant cells)
  • Eczema (squamous cells from epidermis only)
18
Q

What is the reason for carrying out an axillary lymph node FNA?

A

Pre-operative planning

19
Q

What are the indications for carrying out a core biopsy of a breast?

A
  • All cases with clinical OR radiological OR cytological suspicion
  • Breast screening – especially architectural distortion and microcalcification
  • Pre-operative classification
  • Rarely open biopsy
20
Q

What equipment is needed for a core biopsy?

A
  • 14 G needle
  • Intact tissue strand
  • Formalin fixed
21
Q

What are the advantages of core biopsy?

A
  • Confirm invasion
  • Tumour typing and grading
  • Immunohistochemistry – receptor status

Reproductive System (26 decks)

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