Abstract
Fineneedle aspiration cytology was done on mammary tumors in 314 breasts.The aspirated material was immediately smeared onto glass slides and stained by the Papanicolaou method.Of the 80 histologically confirmed mammary carcinoma, 63 (78.8%) had concord ant cytologic diagnosis: 2 (2.5%) were diagnosed as suspected: 11 (13.7%) were false negative: and the smears were inadequate in 4 cases (5.0%).
The purpose of this study was to analyze the reasons for failure to diagnose mammary carcinoma by aspiration cytology.
At first, the relationships between tumor size, histologic types and cytologically positive rate were studied. There was a tendency to smaller size of tumors in cytolagically negative cases as compared with the cytologically positive cases. Among histological types of mammary carcinoma, scirrhous type, which have more abundant fibrosis, show the lowest positive rate cytologically. The degrees of fibrosis were often factors to be considered in explanation of failure to obtain adequate carcinoma cells.
Secondly, cytologic smears from mammary carcinoma which had received false negative or suspected cytologic reports were reevaluated and compared with the observations of smears in which a definite cytologic diagnosis of malignancy had been made.
We observed 9 points concerning smears of concordant positive cases and false negative cases.These 9 points were as follows: Cellular arrangement with irregular overlapping, loose intercellular connection, large nucleocytoplasmic ratio, marked anisokaryosis, marked nuclear pleomorphism, appearance of cells with nuclei over 15μ in diameter, hyperchromasia wtih finely compact chromatin pattern and appearance of cell with nucleoli over 2.5μ in diameter or with more than 3 nucleoli in number.
In the observation of smears from concordant positive cases, more than 4 points were found, while in the observation of smears from false negative or suspected cases, only 2 or 3 points were shown. Even though cytologic smears from rare cases with false positive diagnosis have 2 or 3 points, but, to avoid false negative diagnosis, we concluded that if 2 or 3 points out of the above 9 were found in a given sample of aspirated material, an excisional biopsy should be performed.
