Comunicación
Nº 041
Comunicación |
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Giorgio Gherardi, M.D., Cristina Marveggio, B.D., Stefania Rossi, M.D.
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Cyto-histologic correlation
The score values of the 47 FNA aspirate specimens are illustrated in table 1. Histology revealed 24 cases of FH, 8 cases of premalignant lesions {7 ADH and 1 ALH}, and 15 malignant cases {11 DCIS and 4 IDC}. The cytologic score range for FH was 12 to 16, for premalignant lesions 14 to 17, and for malignant cases 15 to 18. If malignant and premalignant lesions are considered together the PPV of a score value >;16 was 100%, while the NPV of a score value <16 was 66%. Correlation of cytologic score and histologic results allowed identification of three groups of samples (see Table 1): aspirates with minor atypia {11 cases with score <15} including lesions that were diagnosed histologically as benign or premalignant; aspirates with intermediate atypia {25 cases, with score values 15 and 16} including samples of lesions that proved to be benign, premalignant and malignant lesions histologically {15 cases of FH, 4 of ADH, 5 of DCIS and 1 of IDC}; aspirates with marked cytologic atypia {11 cases with score>16) that were diagnosed histologically as premalignant and malignant lesions {2 ADH, 6 DCIS and 3 IDC}. Malignancy in cases scoring >=15 was found in 7/25 premenopausal subjects {28%} and in 8/11 postmenopausal cases {75%}. Of the 11 cases of DCIS, 10 were diagnosed as noncomedo type and one as comedo type; all invasive carcinoma cases were low nuclear grade ductal carcinoma. The diagnosis of atypical hyperplasia (AH) was made in 6 premenopausal and 2 postmenopausal cases: histologically, 7 cases corresponded to ADH and 1 to ALH.
DNA-ploidy analysis
Ploidy assessment identified 33 diploid and 14 aneuploid cases and the determinations performed on touch preparations of the surgical specimens were qualitatively concordant with those obtained on aspirates. All cases of FH fell in the group of diploid proliferations. In the group of diploid proliferations no malignancy was detected in cases with a S+G2/M <=13%; moreover, only 1/8 cases of ADH had a S+G2/M cell fraction under that value, and only 3/24 benign cases exceeded it. Thus the cell kinetic index of 13% was used as a operative cut-off to differentiate slowly proliferating diploid (SPD) from rapidly proliferating diploid (RPD) cell populations. Table 2 shows that of the 22 FNAs with a SPD pattern 21 cases were diagnosed as FH and 1 as AH; conversely, the RPD pattern included 3 cases of FH, 4 of ADH, and 4 malignant cases. Aneuploidy was detected in 3/8 cases of AH {37.5%}, in 9/11 cases of DCIS {81.8%}, and in 2/4 IDC cases {50%}; all the remaining cases of AH, DCIS and IDC were in the diploid range. Within the aneuploid group, 10 samples showed a diploid-triploid pattern and 4 had DI values in the triploid (hyperdiploid) region (range 1.19 to 1.58). No tetraploid, hypertetraploid or hypodiploid cases were found. Seven out of the 10 diploid-triploid cases were diagnosed histologically as DCIS, 1 as ADH, and 2 as IDC. Finally, of the 4 cases showing DI values in the triploid range, 2 cases were diagnosed as ADH and 2 as DCIS ( Table 2). If malignant and premalignant lesions are considered together the PPV of RPD and aneuploid patterns was, respectively, 72% and 100%. The NPV of a SPD pattern was 95%.
Correlation of cytologic score with DNA-ploidy and histologic results
The cases falling in the above score categories showed different patterns of DNA-ploidy and cell kinetics (see Table 3). In the category with minor cytologic atypia there were no cases showing an aneuploid pattern; in addition, no case of AH showed a SPD histogram, while the RPD pattern was observed in 1 case of FH and in 2 cases of ADH. Within the second and most numerous category with intermediate cytologic atypia {25 cases}, the SPD pattern was seen in 13 cases of FH and in 1 of ADH, but in no malignant lesion. An aneuploid pattern was found in 2 cases of ADH and in 4 malignancies. The RPD pattern was found in the remaining 5 cases that histologically included both benign {2 cases of FH} and premalignant or malignant lesions {1 case of ADH, 1 of DCIS and 1 of IDC}. In the category with marked cytologic atypia there was no case showing a SPD pattern; 2/3 cases with RPD pattern and 7/8 aneuploid proliferations were malignant. The 2 remaining cases consisted of AH and showed a RPD and an aneuploid pattern. Data analysis showed that if one amalgamates malignant and premalignant lesions in one category the NPV of a score value <15 increased from 81.8% to 100% if coupled to a SPD pattern and that of a score value>16 increased from 66% to 95% if coupled to a SPD pattern. Similarly, the PPV of a score value >15 increased from 58% to 100% if coupled to an aneuploid pattern, and to 75% if coupled to a RPD pattern. This latter had a PPV of 63% in cases scoring <=16.
Figures 1, 2, and 3 illustrate the morphologic features of FH, ADH, and DCIS, respectively.
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