PROGNOSTIC VALUE OF CYTOLOGICAL GRADING OF FINE-NEEDLE ASPIRATES FROMBREAST CARCINOMAS

Because neoadjuvant therapy, including preoperative chemotherapy and t amoxifen, is becoming increasingly common for early breast cancer, it is desirable to grade tumours before surgery so that the most appropri ate medical regimen can be selected. We have used a cytological gradin g system for ductal carcinoma of type not otherwise specified (NOS). W et-fixed Papanicolaou-stained breast aspirates are examined for the ex tent of cell dissociation, cell size and uniformity, and the appearanc e of nucleoli, the nuclear margin, and chromatin. 377 invasive breast carcinomas were removed after preoperative diagnostic fine-needle aspi ration. cytology (FNAC) during the 25 months of the study. 286 tumours were ductal carcinomas NOS on histology. We established three cytolog ical grades and found that cytological grade corresponded well with th e established histological grades (Elston's modified Bloom and Richard son method). All cytological features included in the score were equal ly important on regression analysis. This study shows that grading of breast cancer on FNAC is feasible and reproducible. Cytological grade may substitute for histological grade, so a combination of FNAC and ma mmography can provide information on tumour type, grade, and size befo re surgery. We recommend this grading system to centres that use FNAC for the diagnosis of breast cancers.