Breast Cytopathology

M. Pinamonti, F. Zanconati

Description

Breast cytopathology is a field characterized by practicality and diagnostic efficacy. This book focuses mainly on morphology, with helpful hints for recognizing benign lesions and the main features of malignancy. It reviews specific features of various lesions and the consequences of the diagnosis for the management of the patient. Each chapter contains high-quality cytology images accompanying the descriptions, including comparison images to distinguish the most important morphological features and to help in the differential diagnosis. Fine needle aspiration cytology (FNAC) sampling and preparation technique, fixation, staining, and principles of its interpretation are covered. Immunocytochemistry and ancillary techniques are outlined, as well as the main clinical and radiological features of breast lesions, and the cytological diagnostics of axillary lymph nodes. This publication will be of great use to medical practitioners in their first approach to breast cytopathology, as well as to pathologists and cytotechnicians with little to moderate experience in the field.

Informations

• Publié par: S. Karger AG
• Date de parution: 27 novembre 2017
• Nombre de lectures: 0
• EAN13: 9783318061413
• Langue: English
• Poids de l'ouvrage: 5 Mo

Extrait

Breast Cytopathology
Monographs in Clinical Cytology
Vol. 24
Series Editor
Philippe Vielh Dudelange, Luxembourg
 
Maurizio Pinamonti Trieste
Fabrizio Zanconati Trieste
Breast Cytopathology
Assessing the Value of FNAC in the Diagnosis
of Breast Lesions
126 figures, 119 in color, 2018
Monographs in Clinical Cytology
Founded 1965 by Georg L. Wied, Chicago, IL
_______________________ Dr. Maurizio Pinamonti Department of Medical Sciences University of Trieste IT--34149 Trieste (Italy)
_______________________ Prof. Fabrizio Zanconati Department of Medical Sciences University of Trieste IT--34149 Trieste (Italy)
Library of Congress Cataloging-in-Publication Data
Names: Pinamonti, Maurizio, author. | Zanconati, Fabrizio, author.
Title: Breast cytopathology : assessing the value of FNAC in the diagnosis of breast lesions / Maurizio Pinamonti, Fabrizio Zanconati.
Other titles: Monographs in clinical cytology ; v. 24.
Description: Basel ; New York : Karger, 2018. | Series: Monographs in clinical cytology ; vol. 24 | Includes index.
Identifiers: LCCN 2017046399| ISBN 9783318061406 (hard cover : alk. paper) | ISBN 9783318061413 (electronic version)
Subjects: | MESH: Breast--pathology | Breast Diseases--diagnosis | Biopsy, Fine-Needle | Breast Neoplasms--diagnosis
Classification: LCC RG493.5.B56 | NLM WP 815 | DDC 618.1/90758--dc23 LC record available at https://lccn.loc.gov/2017046399
 
Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents ® .
Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
© Copyright 2018 by S. Karger AG, P.O. Box, CH-4009 Basel (Switzerland)
www.karger.com
Printed on acid-free and non-aging paper (ISO 9706)
ISSN 0077–0809
ISBN 978–3–318–06140–6
e-ISBN 978–3–318–06141–3
 
Contents
Preface
Chapter 1
FNAC: Sampling and Preparation Technique, Fixation, and Staining
Chapter 2
Principles of Interpretation
Chapter 3
Normal Breast
Chapter 4
Cytology of Inflammatory and Reactive Changes
Chapter 5
Cystic Lesions
Chapter 6
Epithelial Proliferative Lesions
Chapter 7
Fibroepithelial Lesions
Chapter 8
Invasive Carcinoma
Chapter 9
Other Breast Neoplasms
Chapter 10
Assessment of the Lymph Node Status
Chapter 11
Ancillary Techniques
Concluding Remarks
Subject Index
 
Preface
 
Antoine Zajdela would be happy to see the birth of a text atlas of breast cytopathology realized by one of his Italian students who followed with great interest the courses he held annually in Italy in the 1980s and 1990s. Fabrizio Zanconati, besides being a regular attendant, was among the most interested, assimilating from the teacher not only his diagnostic rigor but also the same enthusiasm. Over the years, he has always cultivated this branch of cytopathology becoming the backbone of breast screening in the Province of Trieste. His enthusiasm brought him alongside with the radiologists attending each breast examination that required a deepening through fine-needle aspiration, which he performed firsthand. This allowed him to merge the microscopic evaluation with clinical information, bringing him to a perfect detection and understanding of breast pathology.
His results are the testimony of his great work, and this text atlas, written with Maurizio Pinamonti, educated at the Trieste Cytopathology School, is its fruit. A clear and precise work that will be of great help to those who approach the diagnosis of breast diseases and that will convince even the most skeptical, who prefer other approaches, to the use of cytology diagnostics.
Luigi Di Bonito , Trieste
Chapter 1
Pinamonti M, Zanconati F: Breast Cytopathology. Assessing the Value of FNAC in the Diagnosis of Breast Lesions. Monogr Clin Cytol. Basel, Karger, 2018, vol 24, pp 1–8 (DOI: 10.1159/000479762)
______________________
FNAC: Sampling and Preparation Technique, Fixation, and Staining
What Is FNAC?
Fine-needle aspiration cytology (FNAC) is generally considered a rapid, reliable, safe diagnostic procedure to obtain cellular samples of a lesion via insertion of a thin needle (23–27 G) for subsequent microscopic analysis. It is widely used in a variety of fields and, above all, for superficial palpable masses like many breast lesions. However, under instrumental guidance, FNAC can also be performed on nonpalpable masses; the use of ultrasound guidance largely improves its accuracy in breast diagnostics, reducing sampling errors and avoiding complications [ Liao et al., 2004 ].
In developed countries, mammographic screening programs have been used extensively to detect breast cancer as early as possible in the last 20 years. This resulted in the detection of an increasing number of nonpalpable suspicious or doubtful breast lesions for further investigation. The FNAC report is extremely important because it provides necessary information for the management of patients, i.e., whether to proceed with more invasive diagnostic methods or surgical treatment or not, and helps to decide what kind of operation to perform.
Compared to other more invasive diagnostic techniques, such as core needle biopsy (CNB) and surgical excision, FNAC has many advantages, which are briefly listed below [ Zajdela et al., 1995 ]:
• The examination is easy to perform and quick, requiring few minutes from the time the patient is placed on the bed to the completion of the samples
• The puncture is usually not painful, thus no anesthetic is required due to the small size of the needles, which are even thinner than those used to deliver anesthetics
• It is possible to immediately evaluate the adequacy of the sample and even hypothesize a first diagnosis by the rapid on-site evaluation (ROSE; see below), and thus an immediate repetition of the examination in case of scant or unsatisfactory material is possible
• The fine needle does not cause large tissue damage or serious hemorrhage, side effects such as hematoma formation and pneumothorax are minimized, and in the case of an eventual surgical resection of the lesion, tissue quality is preserved
• By moving the needle inside the lesion during the aspiration, it is possible to sample different lesion parts, potentially improving sensitivity
• The examiner’s hand has tactile perception of the consistence of the lesion
• It is possible to examine several different lesions and axillary lymph nodes in the same session
• In the case of liquid lesions, the examination becomes potentially therapeutic, i.e., cysts may be emptied
• The cost of the procedure is low compared to other diagnostic techniques
Cytology has indeed some limitations; it does not allow an accurate evaluation of tissue architecture even if cells tend to maintain the way they are connected to each other on cytological smears. Some sclerotic or poorly cellular lesions often give unsatisfactory results, and the number of special stains is limited. However, it is possible to collect material for immunocytochemistry by preparing multiple slides from the same lesion or using liquid-based cytology or cell block techniques [ Domanski et al., 2013; Ferguson et al., 2013; Garbar and Curé, 2013 ]. Moreover, FNAC is able to provide optimal material to perform molecular analyses on cancer cells.
Most of the criticism leveled at FNAC is due to its high rate of unsatisfactory examinations [ Willems et al., 2012 ], but this is not the case in every laboratory. FNAC is a specialized technique that needs specific skills to be properly performed and interpreted. The reliability and efficiency of the method depend on the quality of the samples and the experience of the medical staff that performs the aspiration [ Zagorianakou et al., 2005 ]. To get the best results, every single step from sampling to spreading and fixation must be correctly performed. In laboratories with little experience in the field of cytology, CNB should be preferred as first-line diagnostic technique.