INTRODUCTION OF THE CYTOLOGICAL GRADING, THE NUCLEAR-AREA, THE DNA INDEX AND THE DNA HISTOGRAM TYPE IN THE SETTING UP OF A SCORE FOR DUCTALBREAST-CARCINOMA

The present study describes the setting up of a new score which makes it possible objectively to grade ductal breast carcinomas, i.e. not-ot herwise-specified (NOS) cancers on cellular material from fine-needle aspirations (FNAs). For this purpose FNAs from 252 patients - with NOS breast cancers - were smeared onto histological slides fixed in an et hanol-formol-acetic acid mixture, Feulgen-stained and analysed by mean s of a cell image processor. Four parameters were taken into account i n setting up the score, namely the cytological prognostic grade (CPM) of malignancies similar to the Scarff-Bloom-Richardson (SBR) grading t he nuclear area (NA), the DNA index (DI) and the DNA histogram type (D HT). Each of these foul parameters was considered as a ''sub-score'' w hich may take three values, i.e. 1, 2 and 3. The final result may thus range from 4 to 12. Sub-scores of 4 and 5 correspond to a cytological score of I, sub-scores of 6, 7 and 8 to a cytological score of II, su b-scores of 9 and 10 to a cytological score of III, and sub-scores of 11 and 22 to a cytological score of IV. In the present study, the resu lts show 17% of CPM grade 1,52% of CPM grade II and 31% of CPM grade I II cancers. All the cases exhibiting a cytological score of IV (5%) fu lly fit in with the CPM grade III cancers. In the same way, none of th e cases exhibiting a score of I fit in with CPM grade III cancers. The cancers with a CPM grade II fit in with the scores of II and III. It thus seems possible to convert a three-value malignancy grading system (CPM and/or SBR grading) into a four-value one (cytological score). T he main advantage in this latter type of system is that it becomes pos sible to split up the over-large group of CPM grade II cancers. As thi ngs stand we are unable to give any prognostic value for the score pro posed here because our study is prospective only. A study of this type has been necessary so as to provide against problems connected with w ays of preserving specimens that might be used in a retrospective stud y. The bank of clinical and biological data now in existence must be a llowed to mature for a number of years before the prognostic worth of the cytological score can be established, always assuming that such a value exists.