CYTOLOGICAL DIAGNOSIS OF BREAST FIBROADENOMAS: DIAGNOSTIC VERIFICATION DIFFICULTIES, MENSTRUAL CYCLE EFFECTS, AND ALGORITHM OPTIMIZATION
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Abstract
To evaluate the informative value of the cytological method of fine needle aspiration biopsy (TAB) in various histological variants of fibroadenomas and to identify distinctive cytological features that significantly affect the diagnostic algorithm in accordance with the Yokohama classification system.
Materials and methods. A retrospective study of 94 cases of verified breast fibroadenomas was conducted. The patients were divided into two groups according to the histological conclusion: intracanalicular (n = 36) and perecanalicular (n = 58) variants. All patients underwent a LIE before surgical treatment. Cytological preparations were retrospectively verified using the IAC Yokohama system. Cases with uninformative material (category C1) were excluded from the comparative analysis of cytomorphological features as technical artifacts of the fence. The statistical analysis was performed using the χ2 (chi-squared) criterion.
Results. Informative material (categories C2-C3) was obtained in 67% of cases. When analyzing adequate drugs, it was revealed that signs of epithelial proliferation are significantly more often detected in the intracanalicular variant of fibroadenomas (p = 0.028). The perecanalicular variant was characterized by a significantly higher stroma density, which correlated with the technical complexity of the material intake. In the subgroup of patients of reproductive age, there was a tendency to increase the frequency of proliferative changes in the first phase of the menstrual cycle.
Conclusion. Cytological examination remains an important component of the "triple test" in the diagnosis of fibroadenomas. Despite the absence of a clinical division of fibroadenoma types in the WHO classification of 2019, the histological structure of the tumor affects the cellular punctate. When receiving uninformative material or category C3, it is recommended to perform a trepan biopsy to verify the diagnosis.
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References
1. Jayasinghe Y, Simmons PS. Fibroadenomas in adolescence. Curr Opin Obstet Gynecol. 2009; 21(5): 402-406. doi: 10.1097/GCO.0b013e32832fa06b
2. Cerrato F, Labow BI. Diagnosis and management of fibroadenomas in the adolescent breast. Semin Plast Surg. 2013; 27(1): 23-25. doi: 10.1055/s-0033-1343992
3. Larsen TK, Faurschou JP, Bak M, Ryttov NF. Fibroadenoma of the breast--modern strategy of treatment. Ugeskr Laeger. 2003; 165(19): 1979-1983
4. Field AS, Raymond WA, Schmitt F. The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology: Recent research findings and the future. Cancer Cytopathol. 2021; 129(11): 847-851. doi: 10.1002/cncy.22450
5. Kulikov EP, Zagadaev AP. Nepal`piruemy`e opuholi molochny`h zhelez. M.: GE`OTAR-Media, 2015. 152 s. Russian (Куликов Е.П., Загадаев А.П. Непальпируемые опухоли молочных желез. М.: ГЭОТАР-Медиа, 2015. 152 с.)
6. Montezuma D, Malheiros D, Schmitt FC. Breast Fine Needle Aspiration Biopsy Cytology Using the Newly Proposed IAC Yokohama System for Reporting Breast Cytopathology: The Experience of a Single Institution. Acta Cytol. 2019: 1-6. doi: 10.1159/000492638
7. Wong S, Rickard M, Earls P, Arnold L, Bako B, Field AS. The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology: A Single Institutional Retrospective Study of the Application of the System Categories and the Impact of Rapid Onsite Evaluation. Acta Cytol. 2019; 63(4): 280-291. doi: 10.1159/000500191
8. Roca JAF, Tardivon A, Thibault F, El Khoury C, Alran S, Fourchotte V, et al. Diagnostic performance of ultrasound-guided fine-needle aspiration of nonpalpable breast lesions in a multidisciplinary setting: The Institut Curie`s Expiriens. Am J Clin Pathol. 2017; 147(6): 571-579. doi: 10.1093/ajcp/aqx009
9. Carter BA, Page DL, Schuyler P, Parl FF, Simpson JF, Jensen RA, Dupont WD. No elevation in long-term breast carcinoma risk for women with fibroadenomas that contain atypical hyperplasia. Cancer. 2001; 92(1): 30-36. doi: 10.1002/1097-0142(20010701)92:1<30::aid-cncr1288>3.0.co;2-2
10. Ohashi R, Matsubara M, Watarai Y, Yanagihara K, Yamashita K, Tsuchiya S, et al. Cytological features of complex type fibroadenoma in comparison with non-complex type fibroadenoma. Breast Cancer. 2016; 23(5): 724-731. doi: 10.1007/s12282-015-0632-9
11. Bhat A, Vijaya C, Gowda VS. Cystic fibroadenoma: report of a rare case with review of literature. Breast Dis. 2015; 35(1): 49-52. doi: 10.3233/BD-140380
12. Thapa S, Phulware RH, Kumar A, Kishore S. Cytomorphological Features of Complex Fibroadenoma Breast. J Cytol. 2023; 40(4): 220-222. doi: 10.4103/joc.joc_58_23
13. Kabat GC, Jones JG, Olson N, Negassa A, Duggan C, Ginsberg M, et al. A multi-center prospective cohort study of benign breast disease and risk of subsequent breast cancer. Cancer Causes Control. 2010; 21(6): 821-828. doi: 10.1007/s10552-010-9508-7