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Year : 2014  |  Volume : 10  |  Issue : 4  |  Page : 839-845

Grading systems in the cytological diagnosis of breast cancer: A review

1 Department of Pathology, King George Medical University, Lucknow, Uttar Pradesh, India
2 Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
3 Department of Surgical Oncology, King George Medical University, Lucknow, Uttar Pradesh, India
4 Department of Pathology, Era's Medical College and Hospital, Lucknow, Uttar Pradesh, India

Correspondence Address:
Mukta Pujani
Associate Professor, Department of Pathology, Hamdard Institute of Medical Sciences and Research, New Delhi - 110 062
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.140979

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In developing countries, diagnosis of breast carcinoma is still made on fine-needle aspiration cytology (FNAC). For the resource-poor settings, FNAC is cheaper, less invasive and can sample different areas of the lesion compared with core needle biopsy. The role of breast FNA is usually limited to just categorize the lesion as benign or malignant. Prognostic information from cytomorphology, conveyed to the clinician depends upon the cytopathologist's way of formatting the report. PubMed-based literature search collated the information from articles describing the architectural and cytological features studied on breast aspiration smears. This review focuses on cytomorphological features and the different grading systems with their strengths, short-comings, and practical applicability. Eight worldwide articles proposing new methods of grading the cytological smears from breast cancers were published between 1980 and 2006. All the grading methods were developed for the most common type of breast cancer, that is, infiltrating duct carcinoma (not otherwise specified) type, and most of the workers used Papanicolaou-stained smears for the purpose of grading. Moreover, if interpreted carefully FNAC smears can convey information on most of the histological features. Hence, in developing countries, the focus should be on extracting the maximum information from cytological smears, so that a more precise "surgical pathology" type diagnosis can be given, instead of merely reporting as benign or malignant. Among all the discussed grading systems, we suggest grading system by Howell would be most appropriate and closest to the accepted histologic grading system as it applies Scarff-Bloom-Richardson histological grading system with modifications on FNA smears. We recommend it to be followed by all cytopathologists, in order to bring uniformity in the reporting of breast FNAs for grading the malignant lesions.

Abstract in Chinese

乳腺癌的细胞学诊断分级系统:回顾 摘要 在发展中国家,乳腺癌仍以细针穿刺细胞学(FNAC)来诊断。由于资源贫乏,FNAC是便宜,创伤小,相比空芯针活检可以取样不同区域的病变。乳腺细针穿刺活检的作用通常是有限的,只是将病变分类为良性或恶性,传达给临床医生细胞形态学的信息。PubMed文献检索对于描述乳腺穿刺涂片和细胞学特征研究的文章进行了整理。本文重点研究了细胞形态学特征和不同的分级系统及其优点、缺点和实用性。1980年到2006年之间全世界发表了8篇关于建议乳腺癌细胞学涂片新分级方法的文章。所有的分级方法都是对最常见类型乳腺癌,即浸润性导管癌(非其它特殊类型),多数使用巴氏染色涂片以达到分级的目的。如果认真解读FNAC涂片可以传达多数的组织学特征,因此,在发展中国家,应把重点放在从细胞学涂片中提取最多的信息,以便可以考虑更精确的“外科病理学”式的诊断,而不是仅仅报告为良性或恶性。在所有讨论的分级系统中,我们建议采用Howell系统的分级是最适当和最接近公认的组织学分级系统,因为其采用了Scarff-Bloom-Richardson组织学分级系统及改良的细针穿刺涂片。我们建议所有细胞病理学家遵循之,以使乳腺癌细针穿刺分级评估报告达到一致性。 关键词:乳腺癌,癌,细胞学分级,细针穿刺

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