Cytology Patterns in Random Aspirates from Women at High and Low Risk for Breast Cancer

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: Proliferative breast disease is known to be a common finding in women at risk for breast cancer. A group of 263 women defined as being at high risk for developing breast carcinoma underwent random fine-needle aspiration (FNA) of one or both breasts. In addition, a group of 30 low-risk volunteers underwent random FNA of one or both breasts. Using cytomorphologic criteria, only 29% of our high-risk group had normal (non-proliferative) cytology. Nine percent (9%) had apocrine metaplasia. Forty-three percent (43%) of high-risk women had proliferative breast disease with or without apocrine metaplasia and 19% had atypical hyperplasia (proliferative breast disease with atypia). In contrast, 83% of low-risk women had normal cytology, 17% had proliferative breast disease, and none had proliferative breast disease with atypia. The difference in prevalence of normal cytology, proliferative breast disease, and proliferative breast disease with atypia between women at high and low risk for developing carcinoma were all statistically significant (p < 0.01). Nine of the 263 women later developed in situ (n= 6) or invasive (n= 3) breast cancer. Eight of those 9 patients had proliferative breast disease with atypia on a prior random FNA and one had proliferative breast disease. These findings indicate that cytologic evidence of proliferative breast disease and proliferative breast disease with atypia from random FNA is more prevalent in high-risk than in low-risk women; and further that proliferative breast disease with atypia in the random needle aspirates is significantly associated with later cancer development.