A prospective study of the diagnostic accuracy of cytological criteria in the FNAB diagnosis of breast papillomas

Abstract

Seventy-four fine needle aspiration biopsies (FNAB) of breast were selected from the 133 cases with surgical biopsy follow up, from a total of 1,154 consecutive breast FNAB received in a 6-month-period. These 74 cases were reviewed and scored using all relevant cytological criteria for proliferative breast lesions used in our recent retrospective study, without reference to the original cytological and surgical biopsy diagnoses. Of the 42 criteria scored, 13 had a statistically significant association between the cytology score and the presence or absence of a papilloma (PAP), and the sensitivities, specificities and positive predictive values (PPV) of these individual criteria, or a combination of criteria, were derived. It was found that stellate and meshwork tissue fragments and papillary fragments were all highly specific (0.98) for the diagnosis of PAP, with meshwork fragments having the highest PPV (0.93). Stellate fragments (0.41) and papillary fragments (0.24) were less sensitive not only because they occurred less often, but also because they were present in smaller numbers. The presence of a proteinaceous background with macrophages and siderophages or a moderate to marked number of apocrine sheets were useful indicators only when coexisting with at least one of the above three features.