Reproduction Lecture - Breast Anatomy 2 Flashcards
What is the difference between histology and cytology?
Histology = study of microanatomy of cells, tissues and organs as seen through microscope
Cytology = examination of single cell type, often found in fluid specimens
How are cells obtained for cytology?
Is microscopic examination of a thin layer of cells on a slide obtained by:
- Fine needle aspiration (FNA)
- Direct smear from nipple discharge
- Scrape of nipple with scalpel
What is the “triple assessment”?
Breast examination
Radiological images
FNA cytology
What are the different kinds of mass?
- Cystic (fluid)
- Solid
- Area of diffuse thickening
Describe the FNA technique?
- Gather equipment
- Ensure patient comfort and examine to locate lump
- Insert needle 45 degrees and aspirate
- Spread and stain
- Look under microscope
What are important patient and safety considerations for FNA?
- Patient
- Informed consent
- Comfort
- Chaperone
- Safety
- Appropriate PPE
- Dispose of needle
- Care handling fresh material/infection risk
What are some cytology features to determine benign or malignant?
- Epithelial cells of glandular tissues – look for abnormal architecture
- Benign cytology
- Low/moderate cellularity
- Cohesive groups of cells
- Flat sheets of cells
- Bare oval (bipolar) nuclei in background
- Cells of uniform size
- Uniform chromatin pattern
- Malignant cytology
- High cellularity
- Crowding/overlapping of cells
- Loss of cohesion
- Nuclear pleomorphism
- Hyperchromasia
- Absence of bipolar nuclei
What are features of benign cytology?
- Low/moderate cellularity
- Cohesive groups of cells
- Flat sheets of cells
- Bare oval (bipolar) nuclei in background
- Cells of uniform size
- Uniform chromatin pattern
What are features of malignant cytology?
- High cellularity
- Crowding/overlapping of cells
- Loss of cohesion
- Nuclear pleomorphism
- Hyperchromasia
- Absence of bipolar nuclei
What differences are seen cytologically between lobular and tubular carcinoma?
What is the role of cytology?
So role of cytology is to diagnose if malignant or benign, not the exact characteristics, this is done on core biopsy along with grading
Describe the 5 gradings of the cytology scoring system?
- C1
- Unsatisfactory/insufficient cells for diagnosis
- C2
- Benign
- C3
- Atypical (probably benign)
- C4
- Suspicious (probably malignant)
- C5
- Malignant
What is the treatment for cysts?
For cysts, aspiration is curative:
- Fluid discarded unless is bloodstained or there is residual mass
What are advantages and limitations of cytology?
- Advantages
- Simple procedure
- Well tolerated
- Inexpensive
- Immediate results
- Limitations
- Accuracy is not 100% - false positives and negatives
- Invasion cannot be assessed
- Grading cannot be done
- Lesion can be missed in sampling
- Interpretation (features are smiliar)
What are possible complications of FNA?
- Pain
- Haematoma
- Fainting
- Infection, pneumothorax are rare
