Breast FNA

Breast FNAC – Diagnostic categories

The triple test is an important aspect of investigation and diagnosis of breast masses, comprising clinical examination, mammography (and/or  ultrasonography), and fine-needla aspiration cytology (FNAC).  FNAC is widely adopted because of its accuracy, low cost & easy of use.

I’d like to introduce you with the cytological diagnostic categories and show you  corresponding cytological images for each of them.

Five diagnostic categories are used to classify the cytological report:

1 – Inadequate

Insufficient cellularity, blood obscuring cells, drying artifact, mechanical artifact

2 – Negative for Malignancy

All cells presents without nuclear atypical features

3 – Probably Benign Lesion

High cellularity but without nuclear atypia, papillary groups, few isolated cells

4 – Suspicious for Malignancy

Many isolated cells, mixed cell pattern (one presents atypical nuclei),  high nuclear/cytoplasmic ratio, few cells with atypical nuclei

5 – Malignant Lesion

All cells presents with obviously atypical nuclei, isolated or not, necrosis and/or mitotic figures present

Image gallery

 1 – Inadequate

 Thick smears

 Drying artifact

  Mechanical cells disruption

2 – Negative for Malignancy

 Fibrocystic change

 Fibrocystic change

 Fibroadenoma

 Fibroadenoma

 Fibroadenoma

 Fibroadenoma with apocrine change

 Fibroadenoma – Histology (Note the difference between Phyllodes Tumor)

3 – Probably Benign Lesion

 Sclerosing Adenosis

 Sclerosing Adenosis

 Duct Papilloma (note the difference between Papillary Carcinoma)

 Duct Papilloma

 Duct Papilloma

Benign Phyllodes Tumors

 Benign Phyllodes Tumors

 Benign Phyllodes Tumors Histology (Note the difference between Fibroadenoma)

 Lipoma

 Lipoma

4 – Suspicious for Malignancy

 Few cells, slight nuclear atypia

 Isolated cell pattern

 High nuclear/cytoplasmic ratio

 Mixed cell pattern

 Few cell with severe nuclear atypia

5 – Malignant Lesion

 Ductal Carcinoma

 Ductal Carcinoma

 Ductal Carcinoma

 Ductal Carcinoma

 Ductal Carcinoma

 Ductal Carcinoma

 Ductal Carcinoma

 Ductal Carcinoma – Histology

 Mucinous carcinoma

 Mucinous carcinoma

 Mucinous carcinoma – Histology

 Lobular Carcinoma

 Lobular Carcinoma

 Lobular Carcinoma

 Lobular Carcinoma – Histology

 Papillary Carcinoma

 Papillary Carcinoma  (Tall cells variant)

 Papillary Carcinoma  (Tall cells variant)

 Papillary Carcinoma (Tall cells variant) – Histology (Note the difference between duct papilloma)

That’s it, hope you enjoy

Davide