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Atypical aspirates of the breast: a dilemma in current cytology practice
  1. Shuang-Ni Yu1,
  2. Joshua Li2,
  3. Sio-In Wong3,
  4. Julia Y S Tsang2,
  5. Yun-Bi Ni2,
  6. Jie Chen1,
  7. Gary M Tse2
  1. 1 Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
  2. 2 Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
  3. 3 Servico de Anatomia Patologica, Centro Hospitalar Conde de Sao Januario, Macao, China
  1. Correspondence to Gary M Tse, Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Ngan Shing Street, Shatin, Hong Kong; garytse{at}


Aims The probabilistic approach is widely adopted for breast fine needle aspiration cytology. However, a definite cytological diagnosis is not always possible for C3 (atypia) cases, which poses a management dilemma as this represents a mixed category of benign and malignant cases. It would be beneficial to be able to predict malignancy based on specific cytological features in C3 aspirates.

Methods A comprehensive panel of cytological features (including quantitative, cytomorphological and background features) in a large cohort of C3 breast aspirates with subsequent histological excisions was evaluated to identify relevant morphological criteria predicting the risk of subsequent malignancy.

Results A total of 229 C3 specimens with histological follow-up were included. Malignant outcome was found in 30.1% of specimens and the majority were invasive cancers. Features that showed a significant association with malignant outcome included older age (p=0.001), lower percentage of epithelial cell clusters and high percentage of single cells (p=0.002), cribriform architecture in cell clusters (p=0.034), presence of intracellular mucin (p=0.027), increased cell clusters without myoepithelial cells (p=0.048), diminished fibromyxoid stromal fragments (p=0.001), reduced bipolar nuclei (p=0.021) and the presence of necrosis (p=0.023). Except for the percentages of single cells and cell clusters without myoepithelial cells, all other features were shown to be independent risk predictors in multivariate analysis.

Conclusions C3 aspirates were associated with a significant probability of histological malignancy. Certain quantitative, cytomorphological and background features were potentially helpful in predicting the risk of a malignant outcome. The prediction could be clinically useful in the management of C3 cases.


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  • Handling editor Cheok Soon Lee.

  • Contributors S-NY collected the cases, reviewed the slides and wrote the manuscript. JL collected and arranged clinicopathological data of the cases. S-IW and Y-BN reviewed the slides. JYST analysed the data. JC critically reviewed the paper. GMT conceived the idea of the study, reviewed the cases, provided guidance and critically revised the paper. All authors read and approved the final submitted version.

  • Funding S-NY is supported by the National Nature Science Foundations of China (81400664).

  • Competing interests None declared.

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