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Atypia in fine needle aspirates of breast lesions
  1. Phuong Viet The Tran1,3,
  2. Philip C W Lui1,
  3. Alex M C Yu1,
  4. Pham The Vinh3,
  5. Helen H L Chau4,
  6. Tony K F Ma2,
  7. Puay-Hoon Tan5,
  8. Gary M Tse1
  1. 1Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
  2. 2Department of Pathology, North District Hospital, Hong Kong
  3. 3Department of Breast Surgery, Ho Chi Minh City Oncology Hospital, Vietnam
  4. 4Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
  5. 5Department of Pathology, Singapore General Hospital, Singapore
  1. Correspondence to Gary M Tse, Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Ngan shing Street, Shatin, Hong Kong; garytse{at}


Background The atypical category is controversial in fine needle aspiration cytology (FNAC) of the breast; most are benign, but a significant number are malignant. To date, no morphological criterion has been found to be consistent in predicting malignancy.

Aims To evaluate specific cytological parameters and assess their usefulness in predicting histological outcome in a cohort of atypical breast FNAC, in order to establish a set of objective criteria in defining ‘high risk’ atypical breast FNAC.

Methods A retrospective review of 98 cases of atypical breast FNAC with histological correlation was undertaken. The cytological preparations were evaluated for cellularity, percentage of epithelial cell cluster and single epithelial cells, nuclear atypia, nucleus:cytoplasm ratio, percentage of bipolar nuclei, and the presence of stromal fragments, histiocytes and necrosis.

Results 66 of 98 cases (67.35%) showed benign histology and 32 cases (32.65%) showed malignant histology. Compared with the malignant group, the benign group had significantly lower patient age (p=0.05), higher bipolar nuclei (p<0.0001), less degree of nuclear pleomorphism (p<0.0001), lower nucleus:cytoplasm ratio (p<0.0001), lower cellularity (p=0.05) and less necrosis (p<0.001). There was no difference in the percentage of epithelial clusters and single cells, or the presence of stromal fragments and histiocytes.

Conclusions The presence of nuclear pleomorphism, high nucleus:cytoplasm ratio, epithelial cell atypia, low number of bipolar nuclei and necrosis are useful parameters to predict malignancy in atypical FNAC of the breast. Assessment of these factors in atypical FNAC may be helpful in predicting cancer risk and subsequent management decision making.

  • Breast
  • atypica
  • fine needle aspiration cytology
  • carcinoma
  • cytology

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.