Breast Lecture 2 - Cytology and Radiology Flashcards
what is cytology?
miscroscopic exam of a thin layer of cells on a slide obtaained by fine needle aspiration
what is the role of breast cytology?
- cytology is usead as part of a ‘triple assessment’ of patient by surgeon, radiologist and cytopathologist in patients who present with symptoms
- FNA can instantly determine if lesion is benign or cancerous
- useful for assessing enlarged axillary lymph nodes/satellite lesions
when is ultrasound-guided FNA indicated?
if there is an impalpable area seen on ultrasound
benign breast lesion cytology features
- low/ moderate cellularity
- cohesive groups of cells
- flat sheets of cells
- Bare oval (bipolar) nuclei in background
- cells of uniform size
- uniform chromatin pattern
malinant breast lesion cytology features
- high cellularity
- crowding/overlapping of cells
- loss of cohesion
- nuclear pleomorphism
- hyperchromasia - dark staining nuclei
- absence of bipolar nuclei
Though cytology isn’t used to determine what type of malignant tumour is present, occasionaly features may suggest a type. Give a distinguishing characteristic of lobular carcinoma.
Though cytology isn’t used to determine what type of malignant tumour is present, occasionaly features may suggest a type. Give a distinguishing characteristic of tubular carcinoma.
describe the cytology scoring system from C1-C5
- C1 Unsatisfactory/ Insufficient cells for diagnosis
- C2 Benign
- C3 Atypia (probably benign)
- C4 Suspicious (probably malignant)
- C5 Malignant
what are the advantages of FNA cytology?
- Simple procedure - can be done at clinic
- Well tolerated by patients
- Inexpensive
- Immediate results
- can cure breast cysts
what are the limitations of FNA cytology?
- False Negatives
- False Positives
- Invasion cannot be assessed
- Grading cannot be done
- Sampling (lesion missed): small lesions, small tumour in larger area of thickening
- Technical (difficult to examine cells): suboptimal smears (blood, thick, cells smeared)
- Interpretation (features similar)
complications and contraindications of FNA
Complications:
- Pain
- Haematoma
- Fainting
- Infection, Pneumothorax –rare
no contraindications
When investigating bloody discharge from the nipple, FNA can be used by taking a sample of the nipple discharge and spreading directly on to slides. What abnormal cells would you be looking for?
- Duct ectasia macrophages only
- Intraduct papilloma benign cells in papillary groups
- Intraduct carcinoma (DCIS) malignant cells
when would FNA be used to perform a Nipple scrape?
- suspicion of Paget’s disease (looking for squamous cells and malignant cells)
- eczema (squamous cells from epidermis only)
when is a core biopsy performed in the breast?
- all cases with clinical OR radiological OR cytological suspicion of malignancy
- after abnormal breast screening results - especially architectural distorion and microcalcification
- pre-operative classification
- rarely open biopsy
what information can a core biopsy of the breast give you?
- confirm invasion of malignancy into neighbouring tissues
- tumour typing and grading
- immunohistochemistry - receptor status
