Radiology and Cytology of the Breast

Question 1

What is cytology?

Answer 1

Microscopic examination of a thin layer of cells on a slide?

Question 2

How are cells of the breast obtained for cytology?

Answer 2

• Fine needle aspiration
• Direct smear from nipple discharge
• Scrape of nipple with scalpel

Question 3

What considerations need to be made when thinking about FNA?

Answer 3

Patient:

• Informed of procedure?
• Comfort?
• Chaperone?

Safety:

• Appropriate PPE
• Dispose of needle
• Care handling fresh material/infection risk

Question 4

What are signs of benign cytology?

Answer 4

• Low/moderate cellularity
• Cohesive groups of cells
• Flat sheets of cells
• Bare oval (bipolar) nuclei in background
• Cells of uniform size
• Uniform chromatin pattern

Question 5

What are signs of malignant cytology?

Answer 5

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

Question 6

What is the cytology scoring system?

Answer 6

C1 = Unsatisfactory/Insufficient cells for diagnosis 
C2 = Benign 
C3 = Atypia (probably benign)
C4 = Suspicious (probably malignant)
C5 = Malignant

Question 7

What happens in the case of breast cysts?

Answer 7

Aspiration is curative and the fluid is discarded unless:

• Fluid is bloodstained
• There is residual mass

Question 8

What are the complications of FNA?

Answer 8

• Pain
• Haematoma
• Fainting
• Infection, Pneumothorax (rare)