breast - radiology and cytology Flashcards
what is cytology
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
what is the role of cytology
- symptomatic clinic
- triple assessment of patient (by surgeon, radiologist and cytologist)
- sample of main lesion/FNA of axillary node/satellite lesions
(- breast screening - asymptomatic women invited for mammogram, mostly get core biopsy)
what might be felt in a palpable mass
discrete mass
cystic - fluid
solid
diffuse thickening
FNA equipment
23G needle
20ml syringe +/- Cameco holder
alcohol swab
cotton wool, sticking plaster
glass slides, pencil
+/- vial with saline for needle washings
FNA technique - before taking sample
ensure patient is comfortable
examine to locate lump
swab area
localise lump between fingers
FNA technique - taking the sample
insert needle 45 degrees
aspirate using in and out action applying negative pressure on syringe
release pressure and remove needle
- can also use non-suction aspiration technique
when is ultrasound guided FNA used
for an impalpable area seen on US
FNA important considerations - patient
informed of procedure
comfort
chaperone
FNA important considerations - safety
appropriate PPE
dispose of needle
care handling fresh material/infection risk
features of benign cytology - 6
low/moderate cellularity
cohesive groups of cells
flat sheets of cells
bare oval (bipolar) nuclei in background
cells of uniform size
uniform chromatin pattern
features of malignant cytology - 6
high celullarity
crowding/overlapping of cells
loss of cohesion
nuclear pleomorphism
hyperchromasia
absence of bipolar nuclei
what is shown in this image
benign breast cytology
what is shown in this image
malignant breast cytology
making a diagnosis from malignant cytology
usually diagnosis is non-specfic i.e. adenocarcinoma NOS
ocassionally features may suggest type
what is shown here
what are the defining features
lobular carcinoma
cytoplasmic vacuoles
what is shown here
what are the defining features
tubular carcinoma
cells arranged in tubes
what is the cytology scoring system
C1 - unsatisfactory/insufficient cells for diagnosis
C2 - benign
C3 - atypia, probably benign
C4 - suspicious, probably malignant
C5 - malignant
cysts
- treatment
- when would fluid not be discarded
aspiration is curative
fluid discarded unless
- bloodstained
- residual mass
advantages of FNA
simple procedure, can be done at clinic
well tolerated by patients
inexpensive
immediate results
limiatations of FNA
accuracy not 100%, false-ve/+ve
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 of FNA
pain
haematoma
fainting
infection, pneumothorax - rare
contraindications of FNA
none
indications for nipple lesions
bloody discharge from single duct
what diseases can be seen from nipple discharge
what features would be seen
duct ectasia - macrophages only
intraduct papilloma - benign cells in papillary groups
intraduct carcinoma (DCIS) - malignant cells
what diseases would be seen on nipple scrape
what features would be seen
Paget’s disease - squamous cells and malignent cells
Eczema - squamous cells from epidermis only
axillary node FNA - normal or malignant
normal lymph node
axillary node FNA - normal or malignant
metastatic adenocarcinoma
core biopsy - when is it used
all cases with clinical/radiological/cytological suspicion
breast screening - especially architectural distortion and microcalcification
pre-op classification
rarely open biopsy
core biopsy
- what G needle is used
- what is produced
- how is it stored
14G needle
intact tissue strand
formalin fixed
what can be done from a core biopsy
confirm invasion
tumour typing and grading
immunohistochemistry - receptor status
