Cytologic score and DNA-image analysis in the classification of borderlinebreast lesions: A prospective study on 47 fine-needle aspirates

We prospectively evaluated the accuracy of the cytologic score system devel oped by Masood et al. combined with DNA-image analysis in the subclassifica tion of 47 fine-needle aspiration samples with cytologic features of border line breast lesions. Cytologic scores ranged between 12-18. All cases under went surgical excision of the lesion, and histology revealed 24 cases of fl orid hyperplasia, 8 of atypical hyperplasia, and II noninvasive and 4 invas ive ductal carcinomas. DNA-image analysis demonstrated 33 diploid and 14 an euploid cases. Diploid samples were divided into slowly proliferating (S G2/M less than or equal to 13%) and rapidly proliferating (S + G2/M > 13%) cases. By considering florid hyperplasia a "low-risk" lesion and by amalgam ating atypical hyperplasia, and in situ and invasive ductal carcinoma in th e category of "high-risk" lesions, the positive predictive value of a score value > 16 was 100%. In cases scoring less than or equal to 16, the slowly proliferating pattern had a negative predictive value of 95%, while the an euploid and rapidly proliferating patterns had a positive predictive value of 100% and 63%, respectively. We conclude that a combination of cytologic scare evaluation and DNA-image analysis is very useful in differentiating " low-risk" from "high-risk" cases in the field of breast borderline lesions, thus improving the impact of fine-needle aspiration diagnosis on patient, management. (C) 1999 Wiley-Liss, Inc.