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Cytology of the breast
Last reviewed: 17.10.2021
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Cytology of the breast is a diagnostic method based on the evaluation and study of cellular material. We will consider the technique of conducting, indications, decoding results and other nuances of diagnosis.
As a rule, cytology is used in conjunction with other clinical methods that are leading in the modern diagnosis of breast pathologies. The study is valued for its ease of conduct, easy repetition and quickness. This makes it possible to use it to study the dynamics of morphological changes during the period of illness and treatment. The method does not require a lot of money, so it can be used for morphological verification in a hospital or for preventive examinations and monitoring of the condition of people at risk.
As a material for analysis, punctate tumor-like neoplasms, regional lymph nodes, prints and scrapings from the damaged nipple surface, various seals, secretions, prints from pieces of tissue and the surface of the cuts. The experience of using the analysis allows to determine with high accuracy the presence of malignant neoplasm, the tissue belonging of the tumor and the degree of its differentiation.
But the cytological conclusion always ends with the formulation of a preoperative diagnosis, which serves as the basis for developing the tactics of treatment. For an adequate evaluation, the cytologist uses such clinical data as age, sex, localization of the tumor, the phase of the menstrual cycle, where the material is taken for the study, the therapy used (character, dosage). The effectiveness of the technique depends on how the material was obtained and how it was processed.
Indications for conduction
The reliability of cytological diagnosis is considered to be the highest and is 90-97%. Let's consider the main indications for its conduct:
- Determination of neoplasm (malignant, benign).
- Clarification of the stage of spread of the tumor.
- Setting the degree of differentiation of the tumor for its classification (change in shape, cell structure).
- Obtaining data on background changes (formation of granulomas and polyps, chronic inflammation).
- Prognosis of the disease.
- Additional study of bacterial flora.
As a rule, the analysis is carried out with a comprehensive examination, along with other diagnostic methods. For the detection of pathologies of the mammary glands, ultrasound, mammography, pneumocystography is used. When identifying seals, nodules or any other neoplasms, a puncture is taken. If visual changes reveal changes in skin structure and color of the gland, discharge from the nipple, the puncture is mandatory, as there are suspicions of a malignant lesion. The criterion for veracity of cytology is the results of comparison with a planned histological study.
Method of conducting
To identify the various pathologies of the breast, many methods are used. We will consider the technique of conducting a cytological study, which is based on microscopic examination and evaluation of the cellular material obtained from the focus of pathology. This analysis refers to oncomorphology, but it should not be contrasted with histological.
Advantages of diagnosis:
- Harmlessness.
- Rapidity.
- Accessibility and simplicity.
- Possibility of multiple research.
- Using a small amount of material for microscopic examination
The main goal is to establish the correct diagnosis, which will allow to avoid surgical intervention during the biopsy and will make it possible to make an effective treatment plan.
The material for research can be:
- Scraping from the breast tissue or tumor removed during surgery.
- Mammary gland punctate.
- Material from erosive surfaces.
- Discharge from the nipple.
- Impressions from a biopsy.
It is extremely important to obtain a full-fledged material. It should be taken from the lesion focus, and not the surrounding tissues.
- Puncture
It is carried out in a clinical laboratory or a procedure room. It is performed under X-ray control, ultrasound or CT apparatus. This is necessary to control the position of the needle. Before the puncture, the area used is well palpated to determine mobility, connect with surrounding tissues and choose the optimal fixation. The tissues are fixed with fingers and lead an aspirating needle. Upon reaching the focus of the pathology, using a syringe make a couple of sharp sucking movements for the fence material.
The contents of the needle are blown onto a slide or into a container with a solution. If a puncture appears fluid, then under the needle put the tube and collect it. After removing the fluid, the gland tissues are carefully palpated to exclude residual masses, which can be cystic contents.
- Biopsy
Preparations for cytology are allowed to be made from tissues obtained with the help of this method. The imprint is performed by moving the biopsy needle on the glass, while avoiding injuries to the tissues.
- Operational Material
Using a scalpel, a lymph node is cut, a tumor or a seal. The material is obtained by applying a glass to the cut. If the consistency of the tissue is dense, which makes it impossible to make an imprint, then scrape from the surface of the tumor incision.
- Detachable from the breast
A drop of the separated is applied to the glass and a smear is prepared. If the detachable is small, then to obtain a smear with the help of expressing movements, press down on the region of the parotid zone.
- Smear-prints from eroded surfaces
To the hearth of the defeat, I put the glass on which the cellular elements of the detachable remain. You can also use a cotton swab. All received material is sent to the laboratory immediately after the fence.
Decoding of the cytology of the mammary gland
Diagnosis is important in the diagnosis and treatment plan. Its effectiveness largely depends on the methodology of carrying out and decoding. Cytology of the breast is one of the most popular and truthful methods of revealing pathologies. Having received the results, patients should understand that the final conclusion can be made only by a doctor who operates with symptoms, test results, pictures and other data.
Interpretation of the results of cytology is a complex process. Let's consider the basic decoding of the analysis:
- Incomplete result - this conclusion indicates the need for additional research. Most likely, the difficulties arose because of the small volume of cellular material. At such conclusion, the doctor recommends to pass or take place the repeated procedure.
- Norm - tissues taken for analysis contain cells that do not have pathological signs. Extra bodies or inclusions are not detected.
- Benign cells - there are no signs characteristic of cancer cells.
- Non-cancerous cells - abnormal clusters of atypical cells and compounds were found in the tissues studied. But they have a non-tumor origin. Such results may indicate cysts, mastitis or other variants of the inflammatory process.
- Malignant neoplasms - confirm the presence of a cancerous tumor in the mammary gland. The decoding should contain additional information about the stage, boundaries and localization of the tumor. Tumor signs are obvious, there are characteristic clusters.
Completely rely on the information received is not recommended, since even in the cytological conclusion, the errors are quite likely. If a doctor has doubts about the truthfulness of the results, then another sampling of the samples is being foreseen.
[11], [12], [13], [14], [15], [16]
Fluid cytology of the breast
One of the leading methods in determining pathological processes in the body is morphological. It is based on the study of cytological and histological material. Fluid cytology of the breast is considered to be the best way to process tissue material. Preparations prepared on a cytocentrifuge have a single-layer structure and are evenly distributed on a certain surface. This allows to save expensive reagents during immunocytochemical studies. And the results of such diagnostics are convenient to interpret.
The cytologist examines the material, taking into account the clinical and anamnestic data, the results of ultrasound, CT and mammography. To study suitable punctate tumors, discharge from the nipples, fingerprints foci of pathology. In addition to liquid cytology, fixation and staining of materials is used.
[17], [18], [19], [20], [21], [22], [23], [24], [25], [26]
Cytology in the mammary gland cyst
One of the most common diseases of the breast is the cyst. Most pathology appears in patients 35-50 years of age. The cause of the disease are hormonal disorders. Cysts can be one-sided and two-sided, single and multiple. To the diagnosis resorted to appropriate clinical manifestations. The tissues of the glands become denser and hard, there are pains, discharge from the nipples. With palpation, a small formation of a densely elastic consistency is determined.
Cytology in the mammary gland cyst is performed with appropriate indications, which are obtained with the help of mammography, ultrasound and CT. Particular attention is paid to differential diagnosis with cancer and fibroadenoma. A material is used to collect the material. This is because the cyst is a fluid-filled sac. During the study, it is pierced with a special thin needle, and the liquid content is sent for cytological examination.
The main task of the analysis is to identify atypical, that is, cancer cells. If there are no conditions for safe collection of material, manipulation may affect further treatment or other diagnostic procedures have established the presence of metastasis, then puncture cytology is not performed.
[27], [28], [29], [30], [31], [32], [33], [34]
Cytology in breast fibroadenoma
One of the types of tumor lesion of the breast is fibroadenoma. This neoplasm refers to leaf-shaped tumors. The smears used for cytology in mammary fibroadenoma are represented by cubic epithelium and connective tissue elements of the stroma. Fibroadenoma occurs quite often, but leaf-shaped tumors do not exceed 2% of all fibroadenomas.
Such a tumor has the potential to transform into sarcoma due to changes in the malignancy in the stroma. And the presence of the epithelial component may indicate the development of carcinoma. Most often, the neoplasm is localized in the upper and central squares of the gland. In this case, there is no discharge from the nipples or metastases in the lymph nodes.
There are such variants of leafy tumor according to cytology:
- With the presence of epithelial and connective tissue cells.
- With the predominance of epithelial components and a scant amount of connective tissue component.
- With the predominance of cellular elements, similar in content to the cystic cavity.
- With a scanty epithelial or stromal component.
The exact cytological result of fibroadenoma, that is, the benign form of leaf-shaped tumor, is possible only with the first option.
[35], [36], [37], [38], [39], [40], [41], [42], [43]
Cytology in Breast Cancer
Cancerous lesions of the breast are characterized by cellular and nuclear polymorphism, which makes the cytological diagnosis reliable by 90%. Consider the features of cytology in breast cancer and a variety of cancer:
- Colloid cancer - has densely located cells in clusters and the production of mucus in the cytoplasm or in the form of an uncoatedly colored mass, that is, extracellularly.
- Papillary cancer - has a pronounced polymorphism of cellular elements, coarse with uneven contours and hyperchromic nuclei.
- Cancer with a low degree of differentiation - cytology is characterized by a monomorphic picture. The cells have a rounded shape, and the nuclei occupy the central part of the cell. Sometimes the picture is similar to the cytogram of malignant lymphoma.
- Paget's cancer - most cells do not differ from a low-diffused or moderately differentiated form of cancer. There are large bright cells.
- Cancer with flat-metaplasia - there are polymorphic cells that are disposed in an isolated manner with abundant homogeneous cytoplasm and hyperchromic nuclei.
For the study, punctate tumors, punctate regional lymph nodes, secretions and scrapings of the nipple and erosive surfaces, the contents of cystic cavities, tumor or lymph node imaging are used.
The main principles of cytological diagnostics are:
- The difference in cellular composition in pathology and norm.
- Evaluation of the aggregate of cells.
- Application of the pathoanatomical basis.
Each study should end with the formulation of a detailed conclusion. Diagnostic criteria are based on the morphology of the nucleus and cell, consider them in more detail:
- Cell
Has an increased or giant size, which significantly hinders cytology. Similar is observed with lobular, mastitis-like and tubular cancer. There is a change in polymorphism and the shape of cell elements. The state of the nucleus and cytoplasm are disturbed.
- Core
Has increased size, tuberosity, contours uneven. There is polymorphism, hyperchromia and uneven pattern of chromatin. In rare cases, there are figures of cell division.
- Nucleolus
Has an irregular shape and enlarged dimensions. In the affected cell, the nucleoli are much larger than in the healthy one.
The main criterion for the reliability of cytological research is the comparison of the results with histology.
Cytology of secretions from mammary glands
The study of the cellular and bacterial component of the liquid to be separated is the cytology of the secretions from the mammary glands. This method involves taking a smear or a fingerprint to be detached from each nipple and then sowing it onto the nutrient medium.
Causes of secretions can be both pathological, indicating a certain disease, and natural. Thus, in older women, ectasia of the dairy channels with signs of the inflammatory process is observed. Allocations can be caused by intraprostatic papilloma, galactorrhea, traumatic lesions, abscess, fibrotic mastopathy, malignant neoplasms or pregnancy.
The cytology of the mammary gland allows you to recognize the nature of the secretions, to identify their cause and to prescribe an effective treatment. Diagnosis should only be carried out by a qualified physician in the laboratory. The conclusion is made on the basis of the results of the analysis, various diagnostic methods, palpation and individual characteristics of the patient's body.
[48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59]