M.

Paola Cariaggi
FNAC: Fine needle aspiration citology Ease of implementation of the levy
Low total cost of the examination Poor Fast response times for trauma patie
nts Absence of neoplastic dissemination High sensitivity
The fine needle cytology
Prerequisites for a correct cytological diagnosis
Preparation and technically well prepared cytological material representative
of the lesion Experience and expertise of the cytologist
F.N.A.C. breast
Collection techniques
Manuals Technical Support
F.N.A. breast
Collection techniques with manual needle only With syringe with syringe an
chored on a metal support With a needle and suction vacuum pump
Needles, besides being as small as possible, should have the transparent hood to
see the arrival of cytological material
F.N.A.C. breast
Essential point
The lump / thickening must be clearly identified and firmly immobilized between
the index and middle fingers.
This, in addition to facilitating the introduction of the needle, decreases the
blood supply by reducing haemorrhage
Withdraw needle only
Withdraw the syringe
Withdraw the syringe provided with support
Performed by suction vacuum pump
Withdrawals guided instrumental
Drawing on stereotactic
Setting proper preparations
Setting proper preparations
Cellular material deposited on the end of a slide
Superimpose another coverslip and gently drag the other side
Supporting material on another coverslip tilted by 10 ° C and gently move it tow
ard the opposite
Adequacy of preparation
An initial evaluation may be conducted by the sampler immediately after fixation
. A fair amount of material is not always an adequate sample for diagnosis can b
e made of: blood, fat necrosis Zone shiny appearance perlage indicator of adip
ose tissue areas opaque, gray or pink, are the most to appropriate material
Evaluation of the slide with the naked eye or with the aid of a lens
Fixation and staining
In 95 ° alcohol for Papanicolaou staining
With fixative spray for Papanicolaou staining
Dry in MGG staining
Coloring
Papanicolaou: good detail definition of chromatin and cytoplasm, but possible
loss or degeneration of the cellular material May Grünwald-Giemsa: minor detai
l definition of chromatin and cytoplasm, with cellular aggregates can ipercolora
zione
BREAST needle aspiration criteria for using
as confirmation of lesions clinically and / or radiologically suspicious thi
ckening in all clinically and / or radiologically non-suspicious
BREAST needle aspiration using the results
as confirmation of positive clinical and / or radiation, eliminates intraope
rative histologic examination for confirmation of negativity allows: - to reduce
the number of operations on benign lesions - to detect an error of clinical and
/ or radiological
CLASSIFICATION OF A contribution of breast lesions cytology
Assessment of negativity or positivity typing injury assessment of the deg
ree of anaplasia of the tumor for prognostic purposes
Cytological material present in benign lesions
Solid nodule ductal apocrine myoepithelial

Epithelial cells
stromal cells
bipolar naked nuclei fat cells inflammatory cells
Epithelial cells
Myoepithelial cells
Epithelial cells
Epithelial cells
Epithelial cells
Stromal cells
Fat cells
Phlogosis
Evaluation of Negativity or Positivity parameters
changes nuclear cytoplasmic changes structural changes other parameters
Modifications nuclear Increase the size nuclear anisonucleosi Hyper ipocroma
sia or irregular arrangement of chromatin frequent presence of nucleoli more o
r less obvious modifications increase or decrease in the cytoplasmic cytopla
sm variation in the N / C Structural Changes irregular cell clusters and loss
polarity decreased cellular cohesion
Nuclear changes
size and shape of the nucleus
Nuclear changes
intensity and arrangement of chromatin
cytoplasmic changes increase or decrease
cytoplasm of variation in the N / C
Structural changes irregular cell clusters and loss of polarity decreased ce
llular cohesion
BREAST CYTOLOGY (F.N.A.C.) other parameters
amount of cellular material in relation to age of patient presence or absenc
e of: bipolar naked nuclei connective tissue microcalcifications
Bipolar naked nuclei connective tissue microcalcifications
carcinoma with a low average deviation carcinoma carcinoma deviation index
to high index of deviation
colloid
Papillary
carcinoma with a low average deviation carcinoma carcinoma deviation index
to high index of deviation
Papillary
Lobular
ductal
Lobular
ductal
Ductal
carcinoma with a low average deviation carcinoma carcinoma deviation index
to high index of deviation
Medullary
ductal
Tubular
ductal
BREAST CYTOLOGY (FNA) diagnostic problem
related to the removal or construction preparations related to the character
istics of the lesions
BREAST CYTOLOGY (FNA) Problems due to the preparation
Very little or no material material is not representative of the lesion de
generated material for construction or incorrect setting
BREAST CYTOLOGY (FNA) Problems due to the preparation
Causes: sampling and preparation of the preparation done by inexperienced pers
onnel sparsely cellular lesion nonpalpable lesion localization with diffuse
Degenerated material for fixing bad
Degenerated material for incorrect construction
BREAST CYTOLOGY (FNA) Problems related to the characteristics of the lesions
well-differentiated benign tumors particularly atypical
False Negatives:
errors related to the morphology of well-differentiated carcinomas
Fibroadenoma
Tubular
Lobular
Fibroadenoma
Mastopathy
Lobular
Ductal
Fibroadenoma.
False Positives: Errors related to the morphology of benign atypical special
Hyperplane. ATIP. Hyperplane. ATIP.
Atypical hyperplasia, fibroadenoma
Atypical hyperplasia
ACCURACY: SPECIFICITY 'Benign lesions that most frequently can cause false posit
ive
16 14 12 10 8 6 4 2 0
Doubt
Suspicion
Doubt
Suspicion
(43) Year 1997 (6)
(45) Year 1998 (6)
Inflammation Radial Scar
Iperpl.Tip.Atip fibroadenoma
Adenosis sclera. Fibroa. Phyllodes
Mastop.Fibroc.
F.N.A.C. BREAST
Classification recommended by the European Guidelines
Preparation with cellular material absent, poor, adequate sample, prepared witho
ut evidence of malignancy
C1 = Inadequate or faulty construction Benigno C2 = C3 = Doubt
benign)
Prepared with almost all features (atypia probably benign, but with an atypical
presentation of the material that is not common in the benevolence
C4 = C5 = Positive suspect cancer
Prepared very suggestive but not conclusive of malignancy adequate sample, prepa
red with cells characteristic of cancer or other malignancy
C.S.P.O. Reporting
Inconclusive: inappropriate material NEGATIVE: cell morphology in the normal ran
ge DOUBT atypical hyperplasia, atypical SUSPECT CANCER: CANCER POSITIVE cancer c
ells: cancer cells
C1 C2 C3 C4 C5
F.N.A.C. "Quality Assurance" European Guidelines
Parameters
Sensitivity Sensitivity full absolute (C3, C4 and C5) C5 Specificity PPV PPV PPV
C3 C4
Definition
% C5 diagnosed / on to carcinomas aspirated% of lesions identified with the thre
e classes / carcinomas aspirated% of the true value of C2 benign aspirates% of t
he total correct diagnosis C5 C5 C4 diagnostic data% correct compared to the tot
al data C4 C3% correct diagnosis of the total C3 data
Standard
> 60%> 80%> 60%> 98%
BREAST CYTOLOGY: F.N.A. CSPO RESULTS 99
Pos susp. Dubb. Neg. No V. Total Tot. Malige. Invasive Benign In Situ Tot. No hi
stological. Tot Equals. 328 308 20 1 73 402 193 178 15 4 40 237 71 58 13 55 31 1
57 37 33 4 93 729 859 65 57 8 58 398 521 694 634 60 211 1271 2176
Breast cytology: F. No A.
results (processing indicated by the European Guidelines)
5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0
5
4.8
3.1 2.5 1
0.13
0 FN Rate FP Rate
0
Request% <1998 (2311 FNA)
1997 (2556 FNA) 1999 (2176 FNA)
C. S. P. O.
Breast cytology: F. No A.
results (processing indicated by the European Guidelines)
100 90 80 70 60 50 40 30 20 10 0
98
100 100 99.8
96.8 96.5 98
42.5 46.6 45.2
PPV (item Cit.)
PPV (Sos. Cit.)
PPV (Dubb.Cit.)
Request% <1998 (2311 FNA)
1997 (2556 FNA) 1999 (2176 FNA)
Breast cytology: F. No A.
results (processing indicated by the European Guidelines)
25
25
20
22.6
20.8
23.9
15
10
10
11.2 9.4
8.5
5
0
Inada. Rate
Inada. Rate (Approx)
Request% <1998 (2311 FNA)
1997 (2556 FNA) 1999 (2176 FNA)
BREAST CYTOLOGY
After using all the tricks to ensure proper diagnosis, we must accept that a num
ber of preparations are always difficult or impossible to interpret
C. S. P. O.€: Histological 200-2002 Positive Cases used to evaluate
Period Total FNAC cite C3, C4, C5 No news Cases Used
January 2000 - December 2002
8518 2334 167
2167
C. S. P. O. : Positives Histological 200-2002
PPV of FNA cytology for
FNAC answers C3 C4 C5 Total
Ca in situ 32 35 36 103
Benigno Benigno Total invasive Ca (isto.) (fols.-up) 209 503 1125 1837 171 23 72
01 26 0 0 26438561 1168 2167
PPV 55.0% 95.9 99.4 89.5
The PVP Guide 20% 80%> 98%
C. S. P. O. : Histological 200-2002 Positive Role and indications of cytology
PVP of different combinations of FNAC, the clinic, mammography and ultrasonograp
hy
FNAC C3% suspect / positive at the clinic but not to M. and to 'U.S. suspect / p
ositive to M. and to 'U.S. but not the clinical suspect / positive at the clinic
and either the M or the U.S. I suspect / positive on M and U.S. suspect / posit
ive clinical and at the M' U.S. 36.3 (4 / 11) 72.0 (142/197) 75.3 (58/77) 82.4 (
89/108) 83.3 (35/42) FNAC C4% 83.3 (10/12) 94.0 (286/304) 98 , 7 (236/239) 98.5
(265/269) 98.6 (148/150) FNAC C5% 95.4 (21/22) 99.7 (403/404) 99.4 (687 / 691 )
99.5 (650/653) 99.3 (437/440)
BREAST CYTOLOGY typing of the lesion
In theory it would seem possible to give a classification of histological lesion
s in reality it is extremely difficult. Especially, for therapeutic purposes is
not needed, thus exposing himself with unnecessary statements that may be denied
 after a few days dall'istologia
Colloid
lobular
ductal
Papillary
Ductal
tubular
Ductal papillary
BREAST CANCER (F.N.A.) cytological grading
1, with a low average deviation of 2 ° to 3 ° deviation index marked deviation i
ndex
Grade 1
Grade 2
Grade 3
GRADING EVALUATION OF CYTOLOGY
213 reassessed for grading of 6 players with over 10 years of experience witho
ut reassessed anamnestic and clinical information in the selection of cases
were considered only those with all data necessary for assessing
GRADING EVALUATION OF CYTOLOGY parameters considered
age of the patient intervention survival at 5 years or more homogeneity
TNM treatment with N average = 21 N (0 =-N, N + = 1-3, 3 or more = N + +)
GRADING CYTOLOGY survival at 5 years or more
G1 G2 G3 G 1-2
90 84 72 86 p 0.06 p 0.02
GRADING CYTOLOGY: Multivariate Analysis recurrence 5 years or more T1 T2 T2-T3-4
3-4 18.75 1.0 4.28 5.68 NN + N + + 1.0 1.6 2.69 G1 G2 G3 G1 G3-2 1.0 2.
1 2.4 1.0 1.5
P <0.05
BREAST CANCER (F.N.A.)
The material obtained by fine needle aspiration cytology can also be used for bi
ological characterization of the lesion for therapeutic and prognostic