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The breast was
the subject of this years Spring Tutorial. The lectures were held
in the newly appointed seminar rooms opposite to the north cloisters
UCH. Dr Grace McKee gave a very informative talk about FNA
cytology of breast carcinoma: the diagnostic pointers and pitfalls.
It was emphasised that FNA aspiration cytology is an important,
quick, reliable diagnostic procedure. Good sampling, preparation
and staining are also essential. Typing and grading should be attempted
on all carcinomas, though not on scanty or poorly preserved samples.
The abnormal
aspirate may contain:
- increased
cellularity.
- 3D clusters
and single malignant cells.
- enlarged
nuclei, can also have in benign aspirates.
- irregular
nuclear margins never in benign, except in liquid based cytology.
- abnormal
chromatin pattern (granular not a sign)
- abnormal
mitoses (not on its own a feature).
Details of one
of the many excellent examples shown by Dr McKee included a lobular
carcinoma.
- Intracytoplasmic
vacuoles frequently seen but also present in some ductal carcinomas.
- The vacuoles
may produce a signet-ring appearance.
- The cells
are smaller (RBC size).
- Nuclei may
be round to oval but often irregular (in LBC nucleoli become prominent).
Pitfall:
Aspirates often scanty and under diagnosed. Cells may be single
or in clusters if a large in situ component is present.
Conclusion:
FNA aspiration cytology still has a role to play in breast disease.
Cytological material useful for marker studies for ER, PR and also
HER-2/neu status. Immunocytochemistry, and fluorescence in situ
hybridisation can be used. Air-dried smears are good for these studies.
Cell blocks can also be prepared with needle rinse material.
Dr Clive
Wells gave a good overview of the breast screening programme
and the multidisciplinary team involved in the process. There is
still a lack of pathologists willing to attend FNA clinics. These
clinics are good as the results are rapid and can re-assure patients.
Core biopsies have become popular.
A guide for
when to use FNA vs. Core was given
FNA Cytology:
- cysts
- nipple discharge
- diffuse
thickening
- lesion difficult
position
- small lymph
nodes
- Pagets
Core Biopsy:
- stellate
lesions
- low grade
micro calcification
- radiological
indeterminate lesions
- diffuse
lobular carcinoma
- post radiotherapy
Conclusion:
There is a need for quality as there are increased expectations
of the public. The quality of diagnosis has driven audits into these
areas and has therefore improved the service.
Professor
Lakhani gave an interesting talk on how our present pathology
knowledge can be utilised for future molecular work. The methods
currently under study are DNA microarray analysis and proteonomics.
Transcriptional
profiling can be done using microarrays. Many small tissue sections
can be put onto a microscope slide (1,000 specimens). Reference
and tumour RNA, labelled with fluorescent dyes, can be hybridised
using a probe to the microarray. The slides are scanned with a laser
and the intensity of the dyes can be calculated. This can then provide
information on under or over expression of genes. The databases
then set up can provide profiles of estrogen receptor (ER) status.
An example would be for ER negative tumours where the treatment
is not so good as for ER positive tumours. The aim was to identify
these molecules and use as therapeutic targets.
There are however limitations as with all scientific work. Professor
Lakhani concluded by saying that pathologists in the future will
need to work closely with molecular analysis.
The afternoon
workshops were packed with many interesting cases. This years Spring
tutorial was most informative and well organised. Lunch was also
very enjoyable and good reason to circulate amongst the delegates.
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