SYMPOSIUM BREAST CYTOLOGY

19. VISUALIZATION OF NONPALPABLE CHANGES

IN BREAST AND TARGETED CYTOLOGICAL

FINE-NEEDLE ASPIRATION

Kardum-Skelin I¹ ,  Šušterčić D¹ ,    Borovečki A¹ ,   Parigros K¹ ,

Drinković I² ,   Brkljačić B² ,   Brnić Z² ,    Viđak V² ,   Kos N³

Clinic of Internal Diseases and Department of Radiology KB "Merkur"², Zagreb; Private Clinic of Breast Diseases "Dr Nenad Kos" Velika Gorica³

The golden standards in   breast diagnostics are: mammography, ultrasound and targeted FNA of changes under the ultrasound control or stereotactically controlled FNA.

The aim: 1. to analyse the technique of material collection (FNA controlled blindely, by ultrasound or stereotactically); 2. to analyse the number of FNAs performed in each patient and 3. to isolate the incidence of malignant lesions smaller than 1 cm or  incidence of microcalcificate presence.

The examinees and methods: for the last five years, in 3018 patients, 4264 FNAs by cytologists have been performed. In 4009 cases it was guided by ultrasound, in 51 stereotactically guided, and in only 49 cases blindly (palpationally). A fine-needle was used, and the slides were stained according to Pappenheim (MGG).

The results: 1. 1,4 FNAs on each patient; 2. blind FNAs only in 1,1% cases; 3. malignant diagnosis determined in 237 FNAs (7,75%); 4. 17,2% malignant lesions were smaller than 1 cm or only microcalcificates  or in situ neoplasms were identified.      

With the introduction of targeted breast FNAs under the ultrasound control or stereotactically with mammograph, it is possible to detect, early and on time, a malignant growth of minute non-palpable lesions or even only  changes with microcalcificates.

SYMPOSIUM BREAST CYTOLOGY

20. ADVANTAGES AND VALIDITY OF CYTOLOGICAL

FINE-NEEDLE ASPIRATION OF PALPABLE BREAST

LESIONS GUIDED BY ULTRASOUND

Knežević-Obad A, Dodig D

Clinical Department of Nuclear Medicine, Rebro

In a two-year period, 2.464 patients were examined by ultrasound. Due to suspectable changes in the breast, 917 ultrasoundly controlled cytological FNAs were performed. 820 cytological findings were in favour of benign breast lesion without the need for  further therapeutical treatment.

Fibroadenoma was diagnosed in 50 patients, and carcinoma in 47 (later on histologically verified). 22 out of them were palpable, and, therefore, besides a targeted cytological FNA ultrasoundly controlled, FNAs without the ultrasoud control were performed in these cases, too.  In 6 of them the adequate material for cytological analysis was not obtained by "blind" FNA (malignant cells were not found). The incidence of desmoplasia, tumorous necrosis, intense vascularisation, and  tumor in cystically changed breast were the causes of obtaining inadequate material for cytological analysis.

All the mentioned parametres can be removed if a cytological FNA is performed under the ultrasound control, and with adequate blood suppy in the suspected nodes by using colorDopler. Such method of obtaining material for a cytological analysis ensures  cytology an adequate position in the diagnostic algorithm of breast examination, i.e. increases the sensitivity and specifity of the method  itself.

SYMPOSIUM BREAST CYTOLOGY

21. CYTOMORPHOLOGY OF ASPIRATED

BREAST FRAGMENTS AFTER RADIATION -

VALUE AND POSSIBLE ERRORS

Mirjana Marković-Glamočak,  Dubravka Boban,   Mirna Sučić,

Šimun Križanac,  Sunčica Ries,  Koraljka Gjadrov-Kuveždić

Clinical Department of Laboratory Diagnostics, Department

of Cytology, KBC Rebro

We have analysed  morphological changes of glandular breast epithelial cells after the non-radical operation of breast carcinoma and radiation.

The aim of the work was to establish the possibilities of cytological analysis of morphologically palpable changes.

We have monitored 50 patients after the operation and radiation, and analysed 71 aspirated fragments.

In 12 patients the biopsy and pathohistological verification have been carried out.

In two cases carcinoma was cytologically diagnosed which was further pathohistologically confirmed.

In 3/10 (33.3%) cytologically suspected aspirated fragments, recidivism was confirmed by a repeated FNA, and in 7/10 of suspected changes only benign changes were revealed (2 mild ductal proliferation, 2 florid ductal proliferation , 3 adenoses).

In 16 patients the changes disappeared after the first control and in 5 after the second control FNA.

Cytodiagnostics is useful in evaluation and monitoring of palpable changes in the breast after  radiation, but its role is limited. A cytologist has to know if the patient has ever been, and exactly when, radiated. The test results of changed cells, after the period when these changes were not present, suggest a disease recurrence.

SYMPOSIUM BREAST CYTOLOGY

22. SIGNIFICANCE OF A TEAM APPROACH IN

DIAGNOSTICS AND TREATMENT OF BREAST DISEASE

Štoos-Veić T, Kaić G, Znidarčić Ž, Borković Z,

Kozjak D, Stanec Z, Križanac Š

Clinical Hospital "Dubrava"

The development of medicine has provoked the need for mutual expert work  in different medical professions in order to solve a great part of  pathological conditions. The manner of such cooperative work depends, certainly,  on the type of a pathologic process, but the results also depend on appropriate passing of  information by each participant, not only in his own branch, but also on the role of other expert  he/she cooperates with.

The presentation of our patient with both-sided breast tumor shows the importance of adequately organised team approach in this problem area.

The breast secretion is recognized as a significant symptom of breast disease. The cytological examination is a part of initiative diagnostical procedure, by which a greater secretive caused by benign changes in the breast is revealed.  Only in a smaller number of cases,  malignant tumor cells are found in  secretion. There are cases in which this is the only indication of  breast malignoma that cannot be confirmed by other diagnostical procedures.

In our patients,  the diagnostical procedures were performed intentionally in order to detect both-sided tumors whose only manifestation was a secretion from breasts with malignant tumor cells. If it was not for the consistant cooperation among cytologists, radiologists, ultrasound operators, surgeons and pathologists, this, nowdays, surgically curable malignant breast tumor, could not be revealed in time.

SYMPOSIUM BREAST CYTOLOGY

23. IMPORTANCE OF BREAST CYTODIAGNOSTICS

IN A TEAM WORK

Staklenac B,  Hihlik-Babić I,  Margaretić D,  Dmitrović B

Clinical Hospital Osijek, Department of Clinical Cytology

INTRODUCTION:

Cytodiagnostics is a complementary method in  multidisciplinary approach to breast diseases.

AIM:

The evaluation of cytodiagnostics by comparing the mammographic, ultrasound and PHD results in 10 patients with  breast nodes.

MATERIAL AND METHODS:

In the period between January 1, 1997 to March 3, 2000 in the Cytological Unit of KB Osijek, 1591 breast FNAs were performed, out of which 174 (10,9%) under the ultrasound control. The material was obtained by fine needle  aspiration of 22 G and 10 ccm syringe, then dried in the air and stained by standard May-Grunwald Giemsa method.

RESULTS:

Out of the 1591 performed breast FNAs, 660 (41,48%) were inadequate, 686 (43,12%) were benign, 113 (7,10%) suspectable and 132 (8,30%) malignant. The mentioned methods were compared in 10 patients. The correspondence was revealed in 4 of them (regardless to whether it was  benign or malignant disease), while in 6 there was disagreement in some of them.

CONCLUSION:

The cytodiagnostics is a useful method whose aim is to reduce the number of unnecessary operations, and, at the same time, to detect cancer in the earliest possible stage because this makes patients´ survival  longer.

SYMPOSIUM BREAST CYTODIAGNOSTICS

24. CYTOLOGICAL  PRESENTATION OF PATHOLOGICAL

CHANGES IN BREAST FROM TEN-YEAR WORK

Gović A

General Hospital Šibenik

All types of pathological changes in the breast with a special attention paid to the age structure in patients and their correspondence to pathohistological results have been presented by retrospective analysis of cytological results.

400 patients were examined in the monitored period.

The number of examined patients is rising with the age regardless to results of cytomorphological tests on changes.

In the largest number of patients, regardless to the age goups, benign changes with domination of fibrocystic disease were detected. The  observations in work suggest a further detailed examination, including cytological analysis in the monitoring of all  pathologic changes in the breast.

POSTER SECTION

25. PRESENTATION OF A PATIENT WITH

NON-HODGKIN  LYMPHOMA AND BREAST CARCINOMA

Sučić M¹ ,   Boban D¹ ,    Marković-Glamočak M¹ , Ries S¹ ,

Gjadrov-Kuvedžić K¹ ,   Podolski P¹ ,    Metelko-Kovačević J³ ,

Jakić-Razumović J⁴ ,   Hutinec Z⁴ ,    Hlupić Lj⁴ ,   Budišić Z⁴

¹ Clinical Department of Laboratory Diagnostics,

² Department of Oncology,    ³Department of Hematology,

⁴Clinical Department of Pathology, KBC Zagreb

The incidence of 2 or more malignant tumors can be synchronic or metachronic. Simultaneous-synchronic proliferation of two malignant tumors is more frequent in certain hereditary syndromes. Metachron-non-simultaneous occurance of malignant tumors is connected to the influence of chemo-therapy and radiation which damages cell deoxyribonucleic acid (DNA) and causes immunosurpression in patients.

A patient, 66 -year old, is presented in the work, in which, simultaneously,  non-Hodgkin lymphoma (NHL) and breast carcinoma were detected. Simultaneous incidence of breast carcinoma and malignant hematologic disease is frequent in patients with Li-Fraumeni syndrome with the hereditary mutation of p53 gene.