Robinson's Cytological Grading Research Articles

Concordance between cytological and histopathological grading in invasive breast carcinoma – A cross sectional study

Invasive Breast carcinoma means that the cancer has spread beyond the ducts/lobules into the surrounding tissue. The present 2 year study was carried out at a tertiary care hospital to find the concordance between cytological and histopathological grading in invasive breast carcinoma. It included all the 100 cases of invasive breast carcinoma diagnosed on histopathology during this period with available cytology reports. Concordance of Robinson's cytological grading system was calculated in each grade with respect to histological grading. All cases evaluated for presence of metastasis to axillary lymph nodes. We found Concordance rate between cytological and histological grade as 76%. The coefficient of correlation between cytological grade and histological grade was 0.83 and P value was <0.001 which indicated a strong correlation and significant association between the cytological and histological grade. High degree of concordance is seen between cytological and histopathological grading system. Preoperative grading using FNAC helps in determining neo adjuvant chemotherapy as well as prognosis. This grading should be included in cytology reports on a regular basis because it correlates well with histological grade.

Correlation of Nuclear Morphometry with Clinicopathologic Parameters in Malignant Breast Aspirates.

Shilpa GargBackground Nuclear size, shape, chromatin pattern, and nucleolar size and number have all been reported to change in breast cancer. Aim The aim of the study was to quantify nuclear changes on malignant breast aspirates using morphometry and to correlate the morphometric parameters with clinicopathologic features such as cytologic grade, tumor size, lymph node status, mitotic index, and histopathologic grade. Materials and Methods Forty-five cases of carcinoma breast diagnosed on cytology were included in this study. Cytologic grading was performed as per the Robinson's cytologic grading system. Nuclear morphometry was done on Papanicolaou stained smears. One hundred nonoverlapping cells per case were evaluated. Both geometrical and textural parameters were evaluated. Results Comparison of cytologic grades with most morphometric features (nuclear area, perimeter, shape, long axis, short axis, intensity, total run length, and TI homogeneity) was highly significant on statistical analysis. Correlation with tumor size yielded significant results for nuclear area, perimeter, long and short axes, and intensity with p < 0.05. The study of lymph node status and morphometry showed a highly significant statistical association with all the parameters. Mitotic count was significantly associated with all the geometric parameters and one textural parameter (total run length). On correlation of ductal carcinoma in situ and histopathological Grades 1 to 3 with morphometry, it was found that all the parameters except long–run emphasis were highly significant with p < 0.001. Conclusion Morphometry as a technique holds immense promise in prognostication in breast carcinoma.

A Cytohistologic Correlation Study of Breast Carcinoma with Reference to Robinson's Cytologic Grading System

Aim: The present study has been conducted on cases of infiltrating ductal carcinoma of the breast to correlate cytological Robinson's grading system with histological Nottingham modified Bloom–Richardson grading system. Settings and Design: This is a retrospective study conducted on fifty cytologically diagnosed breast carcinoma cases in the Department of Pathology, VIMSAR, Burla, Odisha. Materials and Methods: Fifty cases of cytologically diagnosed breast carcinoma were graded according to Robinson's system, and the respective histopathology slides were graded according to Nottingham modified Bloom–Richardson scoring system. The axillary lymph node (if any) status was also checked for any metastases. The sensitivity, specificity, positive predictive value, and negative predictive value of Robinson's cytological grading system were calculated. Results: The absolute concordance rate between cytological and histological grades was 78% which indicates a strong correlation and significant association. Sensitivity was maximum for Grade II tumors (88.00%) while specificity was maximum for Grade III tumors (97.50%). The positive predictive value was maximum for Grade III tumors (85.71%) while the negative predictive value was maximum for Grade I tumors (94.11%). Lymph node metastases were found in 42% (21 cases) of all the tumors; maximum was (100%) in Grade III tumors. Conclusion: Cytological grade strongly correlates with histological grade and is helpful in selecting the treatment regimen.

A comparative study of three scoring systems on palpable breast aspirates at a tertiary health-care center: A cross-sectional study

Background: The cytological grading system in fine-needle aspiration of breast lumps helps the surgeons to decide the method of management and assess the survival rate. However, till date, no single cytological grading system for breast aspirates has been adapted in routine practice. Hence, a comparative study of three different grading systems was done. Materials and Methods: This is a retrospective study conducted from January 2016 to June 2018. The stained aspirated smears of breast lump were assessed for cytomorphologic features and graded as per the Modified Masood's Scoring Index (MMSI), National Cancer Institute (NCI) Cytological Grading System, and Robinson's cytological grading and compared with histological diagnosis (four categories) and modified Scarff–Bloom–Richardson's scoring system (carcinoma cases). Results: The MMSI system had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of 80%, 100%, 100%, 92.86%, and 94.44%, respectively. The NCI system had a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 60%, 97.44%, 90.0%, 86.36%, and 87.04%, respectively. The Robinson's cytological grading system had a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 100%, 84.62%, 71.43%, 100%, and 88.89%, respectively. Conclusion: Robinson's scoring system is the system with maximum sensitivity and is most effective in subcategorizing only malignant breast lesions. MMSI is the system with maximum specificity, PPV, and diagnostic accuracy, and can be considered as the standard grading system for both benign and malignant breast lesions on cytology.

The comparison between cytological and histological grading of breast cancers in a Nigerian tertiary hospital

Background: Breast cancer is one of the most common cancers in Nigeria. The tumour grade is an important prognostic factor and is also important in treatment of patients. Fine needle aspiration cytology can be used as an initial diagnostic tool for planning definitive management. Grading of tumours on cytology further guides therapeutic decisions. The aim of this study is to compare the correlation between the cytological and histological grading of malignant breast lumps using the Robinson's cytological grading system and Nottingham histological grading system respectively. The Objectives are, to determine the age distribution of breast cancer in our environment, to grade breast cancers cytologically using the Robinson's cytological grading system and to grade breast cancers histologically using the Nottingham histological grading system. Methods: This was a one year prospective study that involved 30 patients who had malignant smears on fine needle aspiration cytology of their breast lump. These smears were graded using the Robinson's cytological grading system and compared with the Nottingham histological grading systems of same lumps obtained from either tissue biopsies or mastectomies. Results: The mean age of the study participants was 50.23±10.11 years with a range of 35-70 years. Most (56.7%) malignat smears were of cytologic grade 3. The histological grade was 2 in 16(53.3%) and 3 in 14(46.7%) of the same breast tissue samples. The grade 2 tumours had the highest concordance rate of 83.3%. The absolute concordance rate between Robinson's cytological and Nottingham histological grading system of breast cancers was 73.3%. Conclusion: The Robinson's cytological and Nottingham histological grading systems showed good correlation. Keywords: Breast Cancer, fine needle aspiration cytology, cytological grading, histological grading

Correlative Study of Cytological Features in Grading of Invasive Breast Carcinoma.

Context:Fine-needle aspiration cytology (FNAC) is a proven diagnostic technique for establishing the benign or malignant character of breast lesions. Several cytological grading systems have been proposed for grading of carcinoma breast, with results similar to histologic grades.Aims:This study sought to evaluate the prognostic value of FNAC in invasive ductal carcinoma of breast by correlating it with histological grade.Settings and Design:Tertiary care hospital, retrospective analytical study.Patients and Methods:One hundred and fifty cases of breast carcinoma that underwent modified radical mastectomy consequent to an FNAC diagnosis were included in the study. Robinson's grading system and Elston–Ellis modification of Scarff–Bloom–Richardson grading system were used to assign cytologic and histologic grades, respectively.Statistical Analysis:The cytological grades were correlated with the histological grades using χ2-test and Spearman's rank correlation coefficient. The individual features of the cytological grades were correlated with the histological grades using Kappa coefficient and χ2-test. Values were considered significant at P < 0.05.Results:A statistically significant association was observed between cytologic and histologic grades (r = 0.97; P < 0.01) with sensitivity and specificity, respectively, of 100% and 93.95% for cytological grade 1, 100% and 100% for cytological grade 2 and 100% and 100% for cytological grade 3. Also, a positive correlation was found between each feature of the cytologic grade and the histologic grade (P < 0.05). Among these, a better correlation was demonstrated by cytological features like cell uniformity (Kappa coefficient = 0.50) and appearance of nucleoli (Kappa coefficient = 0.52).Conclusions:Robinson's cytologic grading system is a reliable grading method on FNAC smears of cases of carcinoma breast. It correlates well with Elston–Ellis modification of Scarff–Bloom–Richardson grade in invasive ductal carcinoma of breast.

Correlation between cytological and histological grading of breast cancer and its role in prognosis

Context:Assigning grade to breast cancer on FNAC provides prognostic information and guides optimal therapy.Aims:The present study was undertaken to grade breast carcinoma on cytology by Robinson's grading system and correlate it with Elstons modified Bloom Richardson histological grading system.Settings and Design:It is a prospective study done on fifty cases of breast cancer reported on cytology.Materials and Methods:Fifty patients who underwent FNAC and mastectomy for breast carcinoma were cytologically and histologically graded. Correlation between cytological and histological grading system was determined. Sensitivity and specificity of Robinson's cytological grading system was calculated in each grade. All cases evaluated for presence of metastasis to axillary lymph nodes.Statistical Analysis Used:Correlation between cytological and histological grading was established using the non parametric Spearman’ s correlation coefficient.Results:Concordance rate between cytological and histological grade was 78%. The coefficient of correlation between cytological grade and histological grade was 0.804 and P value was <0.001 which indicated a strong correlation and significant association between the cytological and histological grade. Sensitivity was maximum in cytological grade I tumors (100%) and least in cytological grade III tumors (45.45%). Specificity was maximum in cytological grade III tumors (94.87%) and least in cytological grade II tumors (72.72%). The incidence of axillary lymph node metastasis was maximum in cytological grade III tumors and grade I tumors.Conclusions:Cytological grade strongly predicts histological grade and is useful in selecting neoadjuvant chemotherapy.

Comparative analysis of six cytological grading systems in breast carcinoma

Background: Fine-needle aspiration cytology (FNAC) gives the necessary information of various breast lesions for surgical management of patients and can be extremely useful for establishing the best neoadjuvant therapy in patients where surgical removal of tumor is not the best option. The National Cancer Institute, Bethesda sponsored conference recommended that the tumor grading on FNAC should be incorporated in reports for prognostication. Objective: The purpose of this study is to determine the correlation between cytomorphologic and histomorphological features and to evaluate the utility of different cytological grading systems and to determine which cytology grade corresponds best to the histology grade. Materials and Methods: The present prospective study included fifty cases of breast carcinoma diagnosed on FNAC and confirmed on histopathology. Detailed cytomorphological features were studied. Cytology grading was done using six grading systems. Detailed histological features were studied, and carcinomas were graded as per modified Scarff-Bloom-Richardson's histopathological grading system. Cytology grading was correlated with histology grading. Results: Out of fifty cases of breast carcinomas, the 29 (58%) cases of each Robinson's cytological grading and Fisher's modification of Black grading correlated with histological grading. The cytological features, namely, nuclear chromatin, nuclear pleomorphism, cell size, nuclear margins, and naked tumor nuclei used in grading correlated well with histological grade. Conclusion: Cytology grading adds to objectivity, reproducibility, and authenticity to the report. The cytology features such as nuclear chromatin, nuclear pleomorphism, cell size, nuclear margins, and naked tumor nuclei had influential role in predicting the final cytology grade. Among the six cytology grading systems, Robinson's system is simple to interpret, more objective, takes less time, and is reproducible and correlates precisely with histological grade as evident from our study. It should be used for routine evaluation of aspirates of breast carcinoma.

Correlation between Robinson’s cytological grading with Modiied Bloom-Richardson histopathological grading for breast carcinoma

Background: Invasive breast carcinoma is the most common carcinoma in women. Fine needle aspiration cytology is the important part of triple assessment of the palpable breast lump. Robinson’s cytological grading can be done in fine needle cytology smears of breast lump. The aim of this study is to grade breast tumor on cytology according to Robinson cytological grading and to correlate with histopathological grading.Materials and methods: This prospective study was done in Department of pathology, Bhaktapur Cancer Hospital from 1st April 2014 to 30thjuly 2015. A total of 58 cases of cytologically confirmed breast carcinoma were included in this study and correlated with histopathological findings. Robinson’s cytological grading was done on cytology smears and modified Bloom-Richardson grading was done on histological sections. Correlation between these two grading was done by using spearman’s correlation coefficient.Results: Cytologically, most common tumor was grade II (62.1%) followed by grade I (19%) and grade III (19%). Histologically, most common tumor was grade II (63.8%) followed by grade III (22.4%) and grade I (13.8%). High concordance rate was found in grade II tumor (80%) with absolute concordance being 65.9%. On cytology, cell dissociation and nuclear margin were determining features (p&lt;0.005). Correlation between cytological grading and histological grading was statistically significant (p&lt;0.005).Conclusion: Robinson’s cytological grading is the easy grading method that can be done on cytology smears of the breast carcinoma to achieve relevant information regarding aggressiveness of the tumor and to plan for neoadjuvant chemotherapy preoperatively.

Significance of nuclear morphometry in cytological aspirates of breast masses

Background:Breast carcinoma is the most common malignancy globally. Cytological evaluation in breast lesions is largely subjective. Gradual progression of cells from normal to invasive involves nuclear changes that need to be viewed objectively.Aims:This study aims to apply nuclear morphometry on cytological breast aspirates. It evaluates its utility in differentiating benign vs. malignant lesions and correlates it with cytologic grading in malignant cases.Setting and Design:Nuclear morphometric parameters of malignant and benign cases were compared. Parameters of malignant cases were correlated with cytologic grading.Materials and Methods:Cytology was used to categorize aspirates from breast lumps into malignant (53 cases) and benign (29 cases). One hundred cells per case in both groups were mapped on DEBEL Cytoscan and six geometrical and three textural parameters obtained were compared. In malignant cases, morphometry was correlated with Robinson’s cytologic grading, which was further correlated in tissue sections (45 cases) with modified Scarff-Bloom-Richardson histologic grading.Statistical Analysis:Students “t”-test was applied for comparison between benign and malignant cases. One-way ANOVA followed by Bonferroni’s post hoc comparison was applied to compare the three cytologic grades. Results were considered significant when P<0.05.Results:Nuclear morphometry successfully differentiated between benign and malignant aspirates and correlated significantly with cytologic grades. Morphometry was especially useful in the diagnosis of atypical ductal hyperplasia and ductal carcinoma in situ. Useful parameters were mean nuclear area, long axis, short axis and total run length. Cytohistologic correlation was 83.3%, 88.9% and 88.9% for cytological grades 1, 2 and 3 respectively.Conclusions:Nuclear morphometry was thus a useful objective tool in the evaluation of breast masses.

Role of cytologic grading in prognostication of invasive breast carcinoma

Background:Evaluation of cytologic features is indispensable in the preoperative diagnosis and grading of infiltrating ductal breast carcinoma (CA) in fine-needle aspiration cytology (FNAC) material and this method can also provide additional information regarding intrinsic features of the tumor as well as its prognosis.Aim:This study has been done to evaluate comparatively the cytologic and histomorphologic grading of infiltrating ductal carcinoma of breast with specific reference to lymph node metastasis and its role in prognostication.Materials and Methods:Forty three patients who underwent FNAC and mastectomy for infiltrating ductal carcinoma were cytologically and histologically graded (employing Robinson's cytologic grading system and Elston's modification of Bloom-Richardson system, respectively). Statistical analysis was done employing ‘z’ test and χ2 test to compare the two grading system and to examine the degree of correlation between the cytologic and histologic grades. Multiple regression analysis was done to assess the significance of every cytologic and histologic parameter. All 43 cases, graded cyto-histologically were also evaluated for presence or absence of metastasis to the regional lymph nodes employing χ2 test.Results:With histologic grade taken as the standard, cytology was found to be fairly comparable, for grading breast carcinoma (overall sensitivity 89.1%, specificity 100%). Further comparison of the two grading systems by Z-test showed that difference between the cytologic and histologic grading was insignificant in all the three grade (P > 0.05). Of the six parameters studied, cell dissociation, nucleoli and chromatin pattern were the most influential features (P < 0.001). The statistically significant difference (p < 0.001) was found in incidences of axillary lymph node metastatic rate in three cytologic grades (15.4% in grade I vs. 83.3% in grade III) as well.Conclusions:Apart from being simple and noninvasive, cytologic grading is comparable to histologic grading and might provide relevant information on the aggressiveness of invasive ductal carcinoma of breast and could be a useful parameter to take into consideration when selecting mode of therapy and to predict tumor behavior.

Robinson′s cytological grading on aspirates of breast carcinoma: Correlation with Bloom Richardson′s histological grading

Background:Cytological grading (CG) on aspirates of breast carcinoma is a useful tool for surgical maneuver and prognosis.Aims:An endeavor was made to use CG on aspirates of breast carcinoma using Robinson's grade and to correlate it with Bloom Richardsons’ histopathological grading.Materials and Methods:A total of 59 patients of breast carcinoma, aged 28-57 years, were aspirated and the smears were graded using Robinson's criteria. All the cases were correlated with Bloom Richardson's grade on histopathology in mastectomy specimens. Lymphadenopathy in 38 cases was aspirated and stained with Papanicolaou and Romanowsky stain.Results:Robinson's CG correlated well with Bloom Richardson's histopathological grading. For grade I and II tumors, there was substantial strength of agreement between cytology and histopathology, while in grade III, the concordance was nearly perfect. Lymph node metastasis was found in 27 of 32 axillary nodes, three of five cervical nodes and the only palpable supraclavicular node. Lymph node metastasis was observed in three with cytological grade II, 28 of grade III and none of grade I. All grade I had stage A, two of grade II had stage B, while all grade III had either stage B or stage C disease.Conclusions:Thus, CG of breast carcinoma correlates well with histopathological grading and may well be useful as a prognostic marker.

Critical appraisal of cytological nuclear grading in carcinoma of the breast and its correlation with ER/PR expression

<b>Background:</b> Cytological nuclear grading is one of the several key prognostic factors that should be addressed in cytological analysis of breast carcinomas. <br><b> Aims:</b> To evaluate different cytological nuclear grading methods on fine needle aspirates of breast carcinomas and its correlation with histopathological nuclear grading as well as with the immunocytochemical expression of estrogen receptor (ER) and progesterone receptor (PR). <br><b> Materials and Methods:</b> The smears from 30 cytologically proven cases of breast carcinoma were graded by - Nottingham's modification of Scarff Bloom Richardson, Fisher's modification of Black's nuclear grading and Robinson's cytological grading methods. 18 cases were available for correlation with histology grading. <br><b> Results:</b> Robbinson's cytological grading system was found to have the best correlation with histopathology grades (<i>P</i> < 0.001) as well as ER (<i>P</i> = 0.003) and PR (<i>P</i> = 0.001) expression on smears.<br><b> Conclusions:</b> The Richardson's cytology grading method is recommended for cytological nuclear grading along with ER / PR expression, without which the cytological diagnosis of breast carcinoma is incomplete.

Robinson Cytologic Grading in Invasive Ductal Carcinoma of the Breast

To correlate the cytologic grade of breast carcinoma with the expression of E-cadherin/catenin system molecules and the presence of metastasis in regional lymph nodes.Aspirate smears were examined together with histologic sections from the corresponding neoplasms taken from 100 patients with invasive ductal carcinoma. In 50 cases, > or = 1 metastatic nodes were identified. Cytologic grading of the smears was performed using the Robinson method. Immunohistochemical expression of E-cadherin and of alpha-, beta- and gamma-catenin was studied.A statistically significant relationship was observed between E-cadherin/catenin expression and cytologic grade (p < 0.0005). This association was particularly relevant to the cell dissociation parameter (p < 0.0005).The cytological grade established in preoperative studies may provide relevant information on the aggressiveness of invasive ductal carcinoma and its tendency to produce regional metastasis. This finding could be particularly useful in cases of breast carcinoma in which neoadjuvant therapy is the method of choice.