p63 Staining of myoepithelial cells in breast fine needle aspirates: a study of its role in differentiating in situ from invasive ductal carcinomas of the breast

Abstract

Aims: One of the limitations of fine needle aspiration biopsy (FNAB) of the breast is in distinguishing invasive carcinoma (IDC) from ductal carcinoma in situ (DCIS). It has been proposed that the presence of myoepithelial cells overlying epithelial malignant cell clusters suggests DCIS. However, the recognition of myoepithelial cells in aspirates may be difficult. The aim of this study was to investigate a new nuclear myoepithelial cell marker, p63, a p53 homologue nuclear transcription factor, in a series of breast FNABs in an attempt to distinguish IDC from DCIS.

Methods: Papanicolaou stained smears from eight cases of pure DCIS and 15 cases of pure IDC with a histologically confirmed diagnosis were submitted to immunocytochemical analysis using the antibody 4A4 against p63. Two pathologists evaluated the presence of p63 positive cells overlying malignant cell clusters and admixed with malignant cells. The frequency of p63 positive cells in DCIS and IDC was compared using Fisher's exact test.

Results: p63 consistently stained the nuclei of myoepithelial cells, either overlying malignant cell clusters and/or admixed with malignant cells. p63 positive myoepithelial cells were seen in all DCIS cases and in nine of the 15 cases of IDC (p = 0.0375). In eight cases (three DCIS and five IDC), scattered p63+ epithelial malignant cells were seen.

Conclusions: Although p63 positive myoepithelial cells are found more frequently in DCIS cases, their presence cannot be used as a criterion to rule out invasion in breast FNABs because they are present in up to 60% of invasive cases.

Figure 1

p63 immunocytochemistry highlighting myoepithelial cells overlying tridimensional malignant clusters. (A) Photomicrography showing a fine needle aspiration of a ductal carcinoma in situ with the typical distribution of p63 positive myoepithelial cells. (B) Similar findings in an invasive ductal carcinoma. Note the presence of intracytoplasmic lumens/vacuoles (arrows). Streptavidin–biotin–peroxidase/diaminobenzidine stain; original magnification: A, ×200; B, ×400.

Figure 2

p63 positive invasive ductal carcinoma not otherwise specified. (A) Note the presence of malignant cells with p63 positive nuclei. (B) Histological section of the same case showing a grade III invasive ductal carcinoma with scattered p63 positive cells. Both streptavidin–biotin–peroxidase/diaminobenzidine stain; original magnification, ×200.