Diagnostic Fine Needle Aspiration Cytology Research Articles

Utility of the United Kingdom National Health Services Breast Screening Program Diagnostic Protocol in Fine-needle Aspiration Cytology with Cell Block Preparation in Cases of Palpable Breast Lumps: A Reliable, Fast, and Accurate Diagnostic Method for the Assessment of Breast Lumps with Histopathologic Correlation.

A palpable breast lump is a common diagnostic problem for clinicians and surgeons. Fine-needle aspiration cytology (FNAC) has many advantages such as less cost, less sample processing time, less pain, less chance of hematoma, and less discomfort. FNAC with cell block preparation further increased both sensitivity and specificity by nearly 100%. With the cell block preparation, we can also use newer tests like estrogen receptor-progesterone receptor-human epidermal growth factor receptor 2. The aim of this study was to derive conclusions about the correlation, including sensitivity, specificity, positive and negative predictive values (NPVs), and the diagnostic accuracy of FNAC, with or without cell blocks, compared to the final histopathology in cases of palpable breast masses. A cross-sectional prospective study was conducted after getting approval from the Human Ethics Research Committee from January 2018 to December 2019, which included 65 patients. Patients diagnosed clinically for breast lumps who underwent diagnostic FNAC with cell block, followed by a histopathological examination at our hospital, were included in the study. FNAC without cell block sensitivity, specificity, positive predictive value (PPV), NPV, efficiency rate, and diagnostic accuracy are 91.3%, 100%, 100%, 90.1%, 86.2%, and 96.5%, respectively. FNAC with cell block sensitivity, specificity, PPV, NPV, efficiency rate, and diagnostic accuracy are all 100%. All of our results beat the standard estimate. Fine-needle aspiration cytology is a patient-friendly, easy, reliable, repeatable, and simple diagnostic test. Whenever it is combined with cell block preparation, improves the accuracy of FNAC diagnosis which is more accurate and comparable to golden-standard biopsy with histopathology examination.

Factors for second non-diagnostic ultrasound-guided fine-needle aspiration cytology in thyroid nodules

IntroductionResults in fine-needle aspiration cytology (FNAC) of thyroid nodules may be non-diagnostic (ND). In these cases, it is recommended to repeat the FNAC. The aim of our study was to evaluate the influence of demographic, clinical and ultrasound (US) characteristics in the recurrence of an ND result in thyroid nodule FNAC. MethodsA retrospective study of ND thyroid nodule FNAC was performed for the period 2017–2020. Demographic and clinical data (age, gender, cervical radiotherapy, presence of Hashimoto's thyroiditis, and TSH value) and US characteristics (nodule size, echogenicity, composition and microcalcifications) were collected at first ND FNAC. ResultsOut of 230 nodules with first ND FNAC (83% women; mean age 60.2±14.1 years), 195 (84.8%) underwent a second FNAC: 121 benign, 63 non-diagnostic, 9 indeterminate and 2 malignant. Nine (3.9%) underwent surgery, only 1 of which showed malignant histology and 26 (11.3%) remained under US monitoring. Demographically, patients with second ND FNAC were older (63.4±14 vs. 59±14 years; P=0.032). Females had lower risk of second ND FNAC (OR, 0.4, 0.2–0.9; P=0.016); risk of second ND FNAC was higher in patients treated with anticoagulant/antiplatelet drugs (OR, 2.2, 1.1–4.7; P=0.03). Previous cervical radiotherapy, family history of thyroid cancer, Hashimoto's thyroiditis and TSH value did not influence the risk of second ND FNAC. On US, nodule echogenicity differed significantly between the ND and diagnostic FNAC, with greater risk of an ND result in hypoechogenic nodules. Microcalcification increased the risk of ND FNAC (OR 2.2, 1.1–4.5; P=0.03). Nodule composition and size did not significantly differ according to ND or diagnostic second FNAC. ConclusionMale gender, advanced age, anticoagulant/antiplatelet drug therapy, hypoechogenic nodules and microcalcified nodules are likely factors for second ND FNAC. Nodules with two ND FNACs were rarely malignant, and a more conservative approach in these cases is not unsafe.

Concordance of breast fine needle aspiration cytology interpretation with subsequent surgical pathology: An 18-year review from a single sub-Saharan African institution.

There are many merits to fine needle aspiration cytology (FNAC) in evaluation of palpable breast lesions. We set out to determine the concordance of breast FNAC interpretation with subsequent surgical pathology in the resource-limited healthcare setting of rural Kenya. African Inland Church Kijabe Hospital electronic pathology files were retrospectively reviewed from 1/1999-9/2017. All breast FNAC cases and subsequent surgical pathology specimens were identified. FNAC interpretations were categorised according to the International Academy of Cytology Yokohama codes: insufficient; benign; atypical favour benign; suspicious favour malignant; and malignant. Surgical pathology results were categorised as benign or malignant. In total, 695 breast FNACs were identified. A total of 219 (31.5%) had subsequent surgical pathology. Average patient age was 39years (range 13-88); 95% were female. Nearly all (98%) lesions were palpable. FNAC interpretive categorisation was as follows: 20 (9%) insufficient, 103 (47%) benign, 16 (7%) atypical, 24 (11%) suspicious and 56 (26%) malignant. On histopathology, there were 141 (64%) benign cases and 78 (36%) malignancies (Table1). The sensitivity of FNAC for detecting malignancy was 85%; specificity was 75%. Positive and negative predictive values were 69% and 88%. Diagnostic concordance between FNAC and histopathology was 79%. For definitively diagnostic FNAC categories, diagnostic concordance was 89%. On histopathology, malignant diagnoses were given in 0 insufficient, 12 (12%) benign, 4 (25%) atypical, 11 (46%) suspicious and 51 (91%) malignant cases. There were five false-positive cytopathology interpretations and 12 false-negatives. FNAC remains a valuable tool in evaluation of palpable breast lesions in resource-limited healthcare settings.

Investigation of the utility of lymph node fine-needle aspiration cytology for the staging of malignant solid tumors in dogs.

Fine-needle aspiration cytology (FNAC) of lymph nodes (LNs) is routinely used for staging canine malignant solid tumors, but studies evaluating its efficacy are limited. The primary objectives of this study were to evaluate the sensitivity/specificity of FNAC and the significance of nondiagnostic FNAC when staging canine malignant tumors. A secondary objective was to determine the prevalence of multiple nodal metastases. Lymph nodes draining malignant solid tumors assessed with FNAC and histopathology were included. The sensitivity/specificity of FNAC was determined for LNs with diagnostic FNAC, using histopathology as the gold standard. The proportion of nondiagnostic FNAC and associated histopathologic prevalence of metastasis were determined. Among the tumors with multiple LNs assessed, the prevalence of multiple nodal metastases was determined. The sensitivity of FNAC (194 LNs) was 67% for sarcomas, 100% for carcinomas, 63% for melanomas, 75% for mast cell tumors, and 100% for other round cell tumors. The specificity varied between 83% and 96%. Nondiagnostic FNAC was reported in 25% of LNs sampled (65/259), most of which were nonenlarged and/or difficult to access, and 20% of which were metastatic on histopathology. When several LNs were assessed (88/189 tumors), the prevalence of multiple nodal metastases was 24%. Histopathologic LN evaluation cannot be robustly substituted with FNAC when staging selected canine solid tumors. When a diagnostic FNAC is elusive, the histopathologic assessment remains ideal. Finally, staging should not always be limited to the assessment of a single LN.

Neoadjuvant letrozole for postmenopausal estrogen receptor-positive, HER2-negative breast cancer patients, a study from the Danish Breast Cancer Cooperative Group (DBCG)

Introduction: Neoadjuvant endocrine treatment (NET) is a low-toxicity approach to achieve operability in locally advanced breast cancer, and to facilitate breast conservation in early breast cancer, particular in patients with highly estrogen receptor (ER) positive and HER2-negative disease. Here, we report the results obtained by neoadjuvant letrozole in patients with early breast cancer in a phase-II design.Material and methods: A total of 119 postmenopausal women with ER-positive, HER2-negative operable breast cancer were assigned to four months of neoadjuvant letrozole before definitive surgery. Sentinel node or diagnostic fine needle aspiration cytology procedure was performed prior to treatment and the women were assessed prior, at two months, and before surgery with clinical examination, mammography and ultrasonography. Surgical specimens were examined for pathological response. Primary outcome was pathological and clinical response.Results: The per protocol population consisted of 112 patients. Clinical response was evaluated in 109 patients and pathological response in 108. Overall a mean decrease in tumor size was 15% (p ≤ .0001). One patient had complete pathological response and 55% of patients had partial pathological response. ER at 100%, ductal subtype, tumor size below 2 cm and lymph node–negative status was significantly associated with a better response to NET and malignancy grade 3 with a poorer response to NET. One patient progressed during treatment and received neoadjuvant chemotherapy. Eight patients received adjuvant chemotherapy due to lack of response.Conclusion: Neoadjuvant aromatase inhibitor therapy is an acceptable strategy in selected postmenopausal patients with ER-rich and HER2-negative early breast cancer with ductal histology and should be considered when chemotherapy either isn’t indicated or feasible.

Can We Improve Thyroid Fine-needle Aspiration Cytology Adequacy in a Low-volume Thyroid Center?

Introduction: Thyroid cancer is the most common endocrine malignancy, and has shown an increase in incidence in recent decades. Fine-needle aspiration cytology (FNAC) is the mainstay of assessment of thyroid nodules and diagnosis of malignancy. Several reports have suggested that ultrasound (US)-guided FNAC has many advantages over palpation-guided biopsy. Methods: Comparison of results of thyroid nodule FNACs in a low volume thyroid center (Northumbria Health Care NHS Foundation Trust) performed by a diverse group of clinicians and radiologists involved in the management of thyroid nodules over 18 months, between October 2008 and April 2010, identified retrospectively from pathology records, with the results of surgeon-performed US (SUS) -guided FNACs performed by a single operator (SRA) recorded prospectively over 17 months between July 2013 and November 2014. Results: The study included 185 FNA, with 104 FNAC being undertaken between October 2008 and April 2010 compared to 81 FNAC between July 2013 and November 2014. There was a statistically significant reduction of non-diagnostic rates in the second period: 23/81 (28%) versus 51/104 (49%) (Fisher’s exact, p=0.0063), non-neoplastic (Thy2) scores remained comparable: 28/81 (35%) versus 32/104 (31%), there were more Thy3 results: 21/81 (26%) versus 15/104 (14%), while the proportion of neoplastic results in the SUS-FNAC group increased: 8/81 (10%) versus 6/104 (6%). Also, time to diagnostic FNAC was significantly shorter in the SUS-FNAC group: 24.2 ± 4.5 versus 54.9 ± 11.4 days (p=0.01, unpaired t-test). Conclusion: SUS-guided FNAC for thyroid nodules is a safe and simple technique. This study demonstrates that it leads to improved patient care by reducing inadequacy rate and time to diagnosis in a low-volume thyroid center.

To evaluate diagnostic utility of Ultrasonography for palpable thyroid nodule and comparison with FNAC in central India.

Objective: Ultrasonographic evaluation of palpable thyroid mass as cystic, solid or mixed, Benign or malignant. To examine the accuracy of Ultrasonographic guided fine needle aspiration cytology (FNAC) in the diagnosis, sensitivity specificity and positive productivity of thyroid nodules. Methods: This is a prospective study of 100 patients with palpable thyroid nodules who underwent Ultrasonography and finding correlated with diagnostic fine needle aspiration cytology (FNAC) over a 2-year period in central India. Results: Palpable thyroid nodules are very commonly seen in the population of central India. This study comprises of 100 patients with male female ratio was 1:4.5. Ultrasonographic evaluation done by various investigators, and able to differentiate a mass lesion into cystic, solid or mixed(100%).We observed out of 100 lesions 26 as cystic,28 mixed and 46 as solid lesions which were later proved by FNAC examination and found 100% accuracy. Among cystic group classification the accuracy was 96%, in solid lesion characterization the diagnostic yield was 87.5% and for mixed lesion to differentiate benign and malignant lesion the accuracy was 93%. Conclusion: Ultrasonography is 100% effective in diagnosing a lesion whether solid, cystic or mixed and help to differentiate a lesion whether malignant or benign. It has added advantage of being safe, reliable, reproducible, cheaper and most important technique without radiation hazard. It also can help in localizing a lesion for biopsy and for guided cyst aspiration. High-resolution thyroid Ultrasonography is a innovative dynamic device for endocrinologists.

Malignancy Risk Analysis in Patients with Inadequate Fine Needle Aspiration Cytology (FNAC) of the Thyroid

BackgroundThyroid fine needle aspiration cytology (FNAC) is the standard diagnostic modality for thyroid nodules. However, it has limitations among which is the incidence of non-diagnostic results (Thy1). Management of cases with repeatedly non-diagnostic FNAC ranges from simple observation to surgical intervention. We aim to evaluate the incidence of malignancy in non-diagnostic FNAC, and the success rate of repeated FNAC. We also aim to evaluate risk factors for malignancy in patients with non-diagnostic FNAC.Materials and MethodsRetrospective analyses of consecutive cases with thyroid non diagnostic FNAC results were included.ResultsOut of total 1657 thyroid FNAC done during the study period, there were 264 (15.9%) non-diagnostic FNAC on the first attempt. On repeating those, the rate of a non-diagnostic result on second FNAC was 61.8% and on third FNAC was 47.2%. The overall malignancy rate in Thy1 FNAC was 4.5% (42% papillary, 42% follicular and 8% anaplastic), and the yield of malignancy decreased considerably with successive non-diagnostic FNAC. Ultrasound guidance by an experienced head neck radiologist produced the lowest non-diagnostic rate (38%) on repetition compared to US guidance by a generalist radiologist (65%) and by non US guidance (90%).ConclusionsThere is a low risk of malignancy in patients with a non-diagnostic FNAC result, commensurate to the risk of any nodule. The yield of malignancy decreased considerably with successive non-diagnostic FNAC.

Update on the management of parapharyngeal tumours

Parapharyngeal space (PPSp) tumours are uncommon and hence the 'generalist expertise' for diagnosis and treatment is limited. Recent improvements in radiology and cytopathology mean the likely diagnosis is more certain and hence the recommended surgical treatment can be more definitive. A wide spectrum of primary pathologies are reported to involve the PPSp; the majority (80%) are benign neoplasms. Radiological imaging, computed tomography (CT) and MRI, with diagnostic fine needle aspiration cytology (FNAC), have continued to increase preoperative diagnostic accuracy. Thus, it is easier to identify the patients whose external surgery may rarely require a mandibulotomy. Only highly selected cases can be safely excised via a transoral approach. All tumours of the PPSp require accurate diagnosis, using modern diagnostic imaging and FNAC. Surgery, in most cases, remains the treatment of choice. Many neurogenic tumours and paragangliomas can be observed in elderly patients. The optimum surgical approach for complete excision needs to be selected on an individual basis. Each patient must be adequately informed of the associated morbidity and possible complications, likelihood of cure and the risk of tumour recurrence - short and long term. Most tumours can be excised safely, and with low risk of recurrence and short hospitalization, with a cervical-parotid approach.

Number of Needle Passes Does Not Correlate with the Diagnostic Yield of Renal Fine Needle Aspiration Cytology

Renal Fine Needle Aspiration Cytology (FNAC) has gained popularity due to increasing options in management of renal lesions such as energy ablation and active surveillance. The diagnostic yield of renal FNAC varies between 40-90%. We hypothesized that adequate and diagnostic FNA samples would be associated with higher number of needle passes and higher number of slides examined. The pathology database at our institution was retrospectively searched for renal FNACs performed between 1995 and 2005. Patient gender, side, indication, cytological diagnosis, final histological diagnosis when available, number of needle passes performed, number of slides examined, and adequacy of the FNAC sample as determined by Diff Quik staining by the cytotechnologist (CS) were recorded. Chi square test was performed for statistical analysis. Out of 377 renal biopsies performed, 259 were core biopsies for medical renal disease, and 118 were FNACs for renal lesions, including 16 for indeterminate complex renal cysts and 102 for solid renal masses. Indeterminate renal cysts were excluded from the study. Out of 102 FNACs for solid renal masses, 22 were inadequate with 13 (59%) being non-diagnostic; and 80 FNACs were adequate with 3 (4%) being non-diagnostic. The number of needle passes was not significantly different between non-diagnostic and diagnostic samples (2.5 vs 3.2); and between inadequate and adequate samples (3.4 vs 3.0). Similarly, the number of slides examined was not significantly different between non-diagnostic and diagnostic samples (9.5 vs 10.9); and between inadequate and adequate samples (11.3 vs 10.6). Diff Quik adequate samples had significantly higher diagnostic yields when compared to Diff Quik inadequate samples (965 vs 41%; p<0.01). The number of needle passes and microscopic slides examined did not correlate with sample adequacy or diagnostic yield of renal FNAC. Sample adequacy as determined by Diff Quik staining correlated with diagnostic FNAC. Despite the retrospective nature of this study, a cytotechnologist should be present during the FNA procedure to ensure adequate samples have been obtained to increase the diagnostic yield of renal FNAC.

Evaluation of Diagnostic Fine Needle Aspiration Cytology in Parotid Gland Masses

Evaluation of Diagnostic Fine Needle Aspiration Cytology in Parotid Gland Masses

Diagnostic fine needle aspiration cytology of primary thyroid lymphoma

Primary thyroid lymphomas (PTL) are extremely uncommon neoplasms accounting for 5% of all thyroid malignancies. There are very few small series and occasional case reports of fine needle aspiration cytology (FNAC) of PTL in literature. We present an interesting and rare case of PTL diagnosed on FNAC. FNAC is an important tool in the diagnosis of thyroid lymphoma.

Ultrasound‐guided fine needle aspiration cytology in the diagnosis and management of thyroid nodules

To examine the accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of thyroid nodules and compare the inadequacy rates for ultrasound-guided and freehand FNAC. A retrospective study of 434 patients with thyroid nodules who underwent diagnostic FNAC over a 2-year period. Cytological diagnoses have been compared with the histological assessment of resection specimens in 69 cases. The inadequacy rate was significantly lower from ultrasound guided FNAC (24/373 cases, 6.4%) than from freehand FNAC (8/61 cases, 13.1%) (P = 0.043). Seventy-six percentage of patients had a non-neoplastic cytological diagnosis and, after multidisciplinary review, the patients were reassured and assigned to clinical follow-up. Sixty-seven patients had a resection for cytological appearances consistent with non-neoplastic disease (n = 34), suspicious of follicular neoplasia (n = 23), or suspicious of malignancy (n = 10), and two patients had resections following inadequate cytology with ultrasound appearances suspicious of a neoplasm. The overall accuracy of FNAC analysis for malignancy was 97.0%, with sensitivity 83.3%, specificity 98.0%, positive predictive value 71.4% and negative predictive value 98.4%. The overall accuracy of FNAC analysis for the prediction of neoplasia was 97.5%, with sensitivity 80.5%, specificity 97.8%, positive predictive value 89.2% and negative predictive value 95.9%. Difficulties in cytological diagnosis were associated with lymphoid infiltrates and with degenerative changes in follicular adenomas. Ultrasound-guided FNAC has a significantly lower yield of inadequate aspirates than palpable FNAC. The ability of FNAC to predict neoplasia in 89% patients and to exclude neoplasia in 95.9% patients makes an important contribution to the multidisciplinary assessment of patients.

Characterization of thyroid 'follicular neoplasms' in fine-needle aspiration cytological specimens using a panel of immunohistochemical markers: a proposal for clinical application

The distinction of benign from malignant follicular thyroid neoplasms remains a difficult task in diagnostic fine-needle aspiration cytology, and some discrepant results have been reported for the individual immunocytochemical markers of malignancy proposed so far. The aim of this study was to test if the combined use of a panel of markers could improve the diagnostic accuracy in the preoperative cytological evaluation of 'follicular neoplasms' in an attempt to reduce the number of thyroidectomies performed for benign lesions. The immunocytochemical expression of galectin-3, HBME-1, thyroperoxidase, cytokeratin-19 and keratan-sulfate was retrospectively analyzed in 125 consecutive fine-needle aspiration samples (cell blocks) of indeterminate diagnoses of 'follicular thyroid neoplasm', and compared with their corresponding surgical specimens, including 33 follicular carcinomas, 42 papillary carcinomas and 50 follicular adenomas. Statistical analysis on each marker confirmed that galectin-3 and HBME-1 were the most sensitive (92% and 80% respectively) and specific (94% and 96% respectively) molecules. The use of these two markers sequentially in non-oncocytic lesions (testing HBME-1 as a second marker whenever galectin-3 proved negative) increased the sensitivity and specificity up to 97% and 95% respectively. In oncocytic lesions, HBME-1 proved to be less sensitive, and the sequential combination of galectin-3 and cytokeratin-19 reached 100% of both specificity and sensitivity. Our data showed that, as compared with the use of single markers, the sequential combination of two markers represents the most accurate immunohistochemical panel in managing patients with a fine-needle aspiration biopsy diagnosis of 'follicular neoplasms', especially in otherwise controversial categories such as oncocytic tumours. The combination of three or more markers did not substantially improve the diagnostic accuracy of the test.

Pitfalls in fine needle aspiration cytology.

A review of pitfalls encountered in fine needle aspiration cytology (FNAC) of all organs and tissues and based mainly on the author's 35-year experience of diagnostic FNAC in clinical practice is presented. Diagnostic difficulties are usually related to deviations from common cytological criteria that may occur in some lesions. Others are due to the effects of the sampling procedure or of the preparation of samples. A few basic rules are proposed, which may help to avoid some of the diagnostic pitfalls.

Doppler ultrasound of the testis in azoospermic subjects as a parameter of testicular function.

Azoospermia frequently represents the end-point of different pathological conditions that cause important quantitative and qualitative alterations of both spermatogenesis and testicular structure, including intratesticular blood vessels. In this study we performed colour Doppler ultrasound of the testis in 12 azoospermic subjects affected by primary testicular pathology (four bilateral post-orchitis, four postradiotheraphy for cancer, four post-traumatic) aged 28.2+/-3.3 (mean+/-SD) years, in six subjects affected by obstructive azoospermia aged 29.7+/-2.4 years and in 20 age-matched fertile subjects (aged 28.6+/-2.5 years). The analysis of intratesticular vessels per organ was quantified using a semiquantitative score: category 0, no vessels visible; category 1, between one and three intratesticular vessels visible; and category 2, more than three vessels visible. In obstructive azoospermic patients and in fertile subjects there were always more than three intratesticular vessels. No intratesticular vessels were detected in eight testes (33.3%) and fewer than three vessels in 16 testes (66.6%) in subjects affected by primary testicular pathology. In azoospermic subjects the testicular structure of the testis was evaluated by diagnostic fine needle aspiration cytology (FNAC) performed in the middle portion of the testis. In non-obstructive azoospermic patients this procedure showed the presence of only Sertoli cells in all cases. When detectable vessels were present, a new aspiration was performed in these areas. In 12 out of 16 cases, spermatogenetic cells including mature spermatozoa, were found when the FNAC was performed in testicular regions showing the presence of blood vessels. These results indicate that colour Doppler sonography of the testis may be useful in the differential diagnosis of azoospermia and suggest the evaluation of the intratesticular blood vessel distribution before performing any method to retrieve intratesticular spermatozoa for intracytoplasmic sperm injection.

Prospective Peer Review in Fine Needle Aspiration Cytology

To analyze the effects of a prospective peer review program on diagnostic accuracy in a routine cytopathology laboratory. For the study, 4,836 consecutive cases subjected to fine needle aspiration cytology (FNAC) over a one-year period were used. Nine pathologists performed both reporting and peer review functions. Disagreements were classified into "diagnostic errors" and "diagnostic discrepancies," depending on their impact on patient care. The effect of this review on turnaround time was statistically analyzed. A retrospective review of 4,025 cases from the preceding year was performed for comparison. Sixty-six cases with diagnostic disagreements were detected by prospective review. There were 28 diagnostic errors and 38 diagnostic discrepancies. The initial turnaround time for diagnostic FNAC in 90% of total cases was < 24 hours; mean delay for the remainder was 3.3 days. Prospective peer review added a further delay of 1 and 1.5 days, respectively. The number of diagnostic disagreements was significantly higher in the retrospective review (P < .01). Prospective peer review of diagnostic FNAC resulted in improved accuracy of diagnosis and reduced potential for inappropriate therapy; however, turnaround time was significantly increased.

Prognostic value of cytological grading of fine-needle aspirates from breast carcinomas

Because neoadjuvant therapy, including preoperative chemotherapy and tamoxifen, is becoming increasingly common for early breast cancer, it is desirable to grade tumours before surgery so that the most appropriate medical regimen can be selected. We have used a cytological grading system for ductal carcinoma of type not otherwise specified (NOS). Wet-fixed Papanicolaou-stained breast aspirates are examined for the extent of cell dissociation, cell size and uniformity, and the appearance of nucleoli, the nuclear margin, and chromatin. 377 invasive breast carcinomas were removed after preoperative diagnostic fine-needle aspiration cytology (FNAC) during the 25 months of the study. 286 tumours were ductal carcinomas NOS on histology. We established three cytological grades and found that cytological grade corresponded well with the established histological grades (Elston's modified Bloom and Richardson method). All cytological features included in the score were equally important on regression analysis. This study shows that grading of breast cancer on FNAC is feasible and reproducible. Cytological grade may substitute for histological grade, so a combination of FNAC and mammography can provide information on tumour type, grade, and size before surgery. We recommend this grading system to centres that use FNAC for the diagnosis of breast cancers.

Fine-needle aspiration cytology of silicone granulomas in the augmented breast.

We studied 12 aspirates from 10 patients who underwent diagnostic fine-needle aspiration cytology (FNAC) of an augmented or reconstructed breast. Six patients were augmented with silicone gel-filled implants and four patients had silicone liquid injections. FNAC indications included a painful or suspicious mass. Excisional biopsy was performed in six cases after FNAC. The findings of eight cases included modestly cellular smears composed of loosely cohesive histiocytes containing vacuoles of various sizes. Multinucleated foreign body giant cells, fragments of dense, amorphous fibrous tissue, and fibroblast nuclei stripped of cytoplasm were also present. Two patients showed a mixture of inflammatory cells characteristic of intramammary lymph nodes or lymphoid aggregates. We conclude that silicone granulomas of the breast show a characteristic set of findings on FNAC which enable a cytopathologist to render a specific diagnosis given an appropriate history of breast augmentation.