Search

The clinical value and limitations of a previously described cytomorphometric method, based on nuclear size and anisonucleosis, for evaluation of routine fine-needle aspiration of the breast were assessed in a series of 313 histologically investigated primary breast lesions. Limitations were analyzed by histomorphometry and DNA flow cytometry in 116 consecutive cases of histologically confirmed breast carcinoma. Eighty per cent of histologically proven malignant tumours were classified cytomorphometrically as malignant and no false-positive results were encountered. For benign lesions a benign cytomorphometric classification was reached in 66% of the cases. Histomorphometry showed that on the whole the assignment of histologically malignant tumours to a non-malignant cytomorphometric classification was determined by smaller nuclei and not by sampling error. Tumours assigned to a malignant cytomorphometric classification had on average significantly higher DNA indices than did tumours not assigned to a malignant cytomorphometric classification (P less than 0.001). The mean-nuclear areas in cytomorphometry and histomorphometry were strongly correlated with DNA indices indicated by DNA flow cytometry (P less than 0.001 for both). The present findings show that this cytomorphometric method is appropriate for routine quality control of a cytological diagnosis of malignancy in FNA of the breast. However, an inconclusive result in 15-25% of the tumours is inevitable.

Material collected by fine needle aspiration (FNA) in 321 histologically examined primary breast lesions of previously untreated patients was analyzed by morphometry. The mean nuclear area (MNA) and its standard deviation (SD) were calculated for 50 cells in each case. Four subclasses were defined on the basis of the MNA and SD: benign (less than 10% probability of malignancy), doubtful benign (10% to 49%), doubtful malignant (50% to 90%) and malignant (greater than 90% probability of malignancy). FNA samples showing signs of acute inflammation or only apocrine metaplastic cells were not suitable for analysis by this morphometric method and were excluded. In 274 (85.4%) of the cases, the measurements allowed a definite morphometric conclusion, with predictive values of 99.5% and 100% for the histologically malignant and benign aspirates, respectively. The probability of malignancy in the doubtful malignant group was almost 86%. The morphometric method described is quick, easy to perform and well suited for use in routine daily practice; furthermore, it does not require expensive equipment. The ease of the technique and its high predictive value make this method appropriate for use as a quality control procedure in FNA cytology.

The preoperative value of target ultrasonic mammography (TUSM) and cytopathology, combined with clinical examination and mammography, was studied in 146 mammographically demonstrated round-shaped breast lesions. All lesions were biopsied and histology was performed. Advantages of combining TUSM with cytology are the possibility to have a more precise puncture aspiration with TUSM and a subsequently higher predictive value, compared to each technique alone.