Can cytological findings predict intraductal spread of breast cancer? Histopathological case-control study

An important predictive factor for local recurrence after breast-conserving therapy is the state of the surgical margin. In order to obtain a negative surgical margin, the present case-control study was conducted to determine whether the extent of ductal spread can be estimated from the information obtained by fine-needle aspiration (FNA). Samples from 69 cases of extensive ductal spread (EDS) in which it was thought that cancer cells had remained in the residual breast when the lumpectomy was performed with 2 cm margins, were retrieved and compared with 62 cases having almost the same clinical and pathological tumor size. The cases of EDS included a significantly larger number of papillotubular carcinomas (37%vs 13%, P = 0.004) and displayed a high nuclear atypia (42%vs 26%, P = 0.001). We could estimate the same tendency with cytological studies. Cancer cells with cohesive papillary-like clusters suggesting papillotubular carcinoma and with a large nuclear diameter were significantly more numerous in cases of EDS (P < 0.01). In conclusion, EDS can be determined by estimating histological type via cytodiagnosis and measuring the nuclear diameter of cancer cells.