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. 2022 Sep 20;14(9):e29385.
doi: 10.7759/cureus.29385. eCollection 2022 Sep.

Cytological Grading of Breast Carcinomas and Its Prognostic Implications

Koshalya Rajendran  1 , Muthu Sudalaimuthu  1 , Shivashekar Ganapathy  1
Affiliations

Cytological Grading of Breast Carcinomas and Its Prognostic Implications

Koshalya Rajendran et al. Cureus. .

Abstract

Introduction Determining the histological grade of breast carcinomas before mastectomy is necessary to decide about neoadjuvant chemotherapy. Core needle biopsies used for this purpose often under-grade the tumour. The grade obtained from fine needle aspiration cytology samples will help in such situations and whenever biopsy is not done, as in a resource-poor setup. Many studies are being done to find out the cytological grading system that correlates well with histological grading. Methods This study was done between 2016 and 2019 including the cases in which both modified radical mastectomy and fine needle aspiration of the tumour had been done. Robinson's cytological grading was done in Papanicolaou and haematoxylin & eosin (H&E) stained cytology smears and correlated with modified Bloom-Richardson histologic grading done in modified radical mastectomy specimens. We also studied the prognostic significance of Robinson's method by studying the association between cytological grade and lymph node metastasis. Results Sixty cases were studied. The two methods had the same grade in 49 (81.7%) cases. They showed a significant positive correlation (Spearman correlation coefficient 0.848, p-0.0001), significant association (Chi-square test, p-0.0001), and substantial agreement (kappa value 0.72). Multiple regression analysis showed chromatin score and nucleoli score as the most influential parameters. Lymph node metastasis showed significant association with cytological grade (p-0.0003), cell dissociation score (p-0.0001), nucleoli score (p-0.01), and chromatin score (p-0.04). Conclusion Robinson's cytological grading is a simple, reliable adjunct/alternative to core needle biopsies for grading breast carcinomas before mastectomy. Hence, it can be made a part of routine cytology reporting of breast carcinomas. Further long-term studies will help in confirming its prognostic significance.

Keywords: breast cancer; breast carcinoma; core needle biopsy; cytological grading; fine needle aspiration cytology; histological grading.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Grade I tumour – cell arrangement
FNAC smear showing high cellularity and cells arranged predominantly in clusters – Cell dissociation score 1 (FNAC - H&E x 40) FNAC: fine needle aspiration cytology; H&E: hematoxylin and eosin
Figure 2
Figure 2. Grade I tumour – cellular features
Grade I tumour with score 1 for cell size, cell uniformity, nucleoli, nuclear margin, and chromatin (FNAC - H&E x 400) FNAC: fine needle aspiration cytology; H&E: hematoxylin and eosin
Figure 3
Figure 3. Grade II tumour cytology
FNAC smear from a grade II tumour showing cells with score 2 for cell size, cell uniformity, nuclear membrane, chromatin, and cell dissociation. (FNAC - H&E x 400) FNAC: fine needle aspiration cytology; H&E: hematoxylin and eosin
Figure 4
Figure 4. Grade III tumour – cell arrangement
FNAC smear showing high cellularity with cells arranged mainly as single cells - cell dissociation score 3 (FNAC - Papanicolaou stain x 40) FNAC: fine needle aspiration cytology
Figure 5
Figure 5. Grade III tumour – cellular features
Grade III tumour with score 3 for nucleoli, cell uniformity, and cell size (FNAC - H&E x 400) FNAC: fine needle aspiration cytology; H&E: hematoxylin and eosin
Figure 6
Figure 6. Grade III tumour – chromatin score
Grade III tumour with score 3 for chromatin score (FNAC - Papanicolaou stain x 400) FNAC: fine needle aspiration cytology
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