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Cancer (Cancer cytopathology) April 25, 2009;117(2):137-47 Breast fine-needle aspiration samples reported as proliferative breast lesion: Clinical utility of the subcategory proliferative breast lesion with atypia

Chengquan Zhao, MD 1 2 *§, Anwar Raza, MD 1 3, Sue E. Martin, MD, PhD 1, Jiangqiu Pan, MD 1, Timothy S. Greaves, MD 1, Camilla J. Cobb, MD 1 3

1Department of Pathology, Los Angeles County + University of Southern California Medical Center, Los Angeles, California 2Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 3Department of Pathology, Loma Linda University Medical Center, Loma Linda, California

email: Chengquan Zhao (zhaoc@upmc.edu)

^*Correspondence to Chengquan Zhao, Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15213

Presented at the 96th annual United State and Canadian Academy of Pathology Meeting in San Diego, California, March, 2007.
Fax: (412) 641-1675
^§The authors thank Dr. R Marshall Austin (Magee-Womens Hospital, University of Pittsburgh) for his help in reviewing this article.
setDOI("ADOI=10.1002/cncy.20003")

Keywords

atypical proliferative breast lesion • fine-needle aspiration • breast cytology

Abstract

BACKGROUND:

The fine-needle aspiration (FNA) diagnosis of proliferative breast lesion is an indeterminate category. The aim of this correlative study was to determine whether a subcategory of proliferative breast lesion with atypia was achievable and whether this subcategory has management utility.

METHODS:

Breast FNA cases from 2000 through 2005 diagnosed as proliferative breast lesion and proliferative breast lesion with atypia were retrieved. Both cytologic and surgical slides of these cases were reviewed blindly. A cytologic diagnosis of proliferative breast lesion (without atypia) or proliferative breast lesion with atypia was used if the findings of the proliferative breast lesion did not fit a more specific category.

RESULTS:

Of the 3934 breast FNAs performed on palpable breast masses from January 2000 to December 2005 at the LAC + USC Medical Center, 317 (8.1%) were diagnosed cytologically as proliferative breast lesion with atypia, without atypia or without mention of atypia. There was subsequent histopathology on 201 of these cases. After the cytologic smears were reviewed, 29 cases were excluded from this study. Of the 172 remaining cases, 21 (12.2%) were found to be malignant and the remaining 151 (87.8%) were found to be benign on histology. Of the malignant cases, 90% had an FNA diagnosis of proliferative breast lesion with atypia; of the benign cases, 78% were interpreted as proliferative breast lesion without atypia.

CONCLUSIONS:

Proliferative breast lesion with atypia was clinically significant because it was associated with a significantly increased likelihood of malignancy compared with proliferative breast lesion without atypia. Most of the malignancies had hypocellularity or low nuclear grade on the FNA smears. Fibroadenoma accounted for most of the benign lesions in both proliferative breast lesion and proliferative breast lesion with atypia. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.

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Received: 28 August 2008; Revised: 13 November 2008; Accepted: 10 December 2008