Tumor cell (dys)cohesion as a prognostic factor in aspirate smears of breast carcinoma

As the ability of fine-needle aspiration biopsy to separate benign from malignant lesions approaches its limits, the potential to provide additional prognostic information based on these same specimens has received increasing attention. An area we have pursued is based on the recognized finding that many neoplastic cells exhibit altered expression of intercellular adhesion molecules. In this study, we evaluated a large number of preoperative fine-needle aspiration smears (83 cases) of histologically proven primary breast ductal carcinoma in an attempt to correlate the degree of cellular dyscohesion in the aspirate with the presence of local (ipsilateral axillary lymph node) metastases. We found that although the smear pattern of primary tumors greater than 3 cm showed no correlation with the presence of positive axillary nodes, the degree of tumor cell dyscohesion of tumors less than 3 cm (60 cases) as seen in aspirate smears did correlate with the presence of regional metastases. Poorly cohesive primary tumors were always associated with local metastases (4 of 4 cases, 100%) compared with those of intermediate (15 of 37 cases positive, 40%) and high cohesion (5 of 19 cases positive, 26%). Thus, we believe the evaluation of tumor cell (dys)cohesion in cytologic smears shows great promise as a simple, cost-effective technique to predict the biologic behavior of breast carcinoma.