Cytologic score and DNA-image analysis in the classification of borderline breast lesions: a prospective study on 47...

We prospectively evaluated the accuracy of the cytologic score system developed by Masood et al. combined with DNA-image analysis in the subclassification of 47 fine-needle aspiration samples with cytologic features of borderline breast lesions. Cytologic scores ranged between 12-18. All cases underwent surgical excision of the lesion, and histology revealed 24 cases of florid hyperplasia, 8 of atypical hyperplasia, and 11 noninvasive and 4 invasive ductal carcinomas. DNA-image analysis demonstrated 33 diploid and 14 aneuploid cases. Diploid samples were divided into slowly proliferating (S + G2/M < or = 13%) and rapidly proliferating (S + G2/M > 13%) cases. By considering florid hyperplasia a "low-risk" lesion and by amalgamating atypical hyperplasia, and in situ and invasive ductal carcinoma in the category of "high-risk" lesions, the positive predictive value of a score value > 16 was 100%. In cases scoring < or = 16, the slowly proliferating pattern had a negative predictive value of 95%, while the aneuploid and rapidly proliferating patterns had a positive predictive value of 100% and 63%, respectively. We conclude that a combination of cytologic score 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.