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 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 thi

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 llular cohesion irregular cell clusters and loss of polarity decreased ce

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 to high index of deviation colloid Papillary carcinoma with a low average deviation carcinoma to high index of deviation Papillary Lobular ductal Lobular ductal Ductal carcinoma with a low average deviation carcinoma to high index of deviation Medullary ductal Tubular carcinoma deviation index carcinoma deviation index carcinoma deviation index

ductal BREAST CYTOLOGY (FNA) diagnostic problem related to the removal or construction preparations 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 related to the character

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