Fine Needle Aspiration Cytology of the Breast: Atlas of Cyto-Histologic Correlates

Contents
Contributors
1: Anatomy and Physiology of the Breast
	1.1	 Anatomy of the Breast
	1.2	 Physiology of the Breast
		1.2.1	 Development
		1.2.2	 Puberty and Menarche
		1.2.3	 Menstrual Cycle
		1.2.4	 Pregnancy and Lactation
		1.2.5	 Menopause
	References
2: Basic Histopathology of Breast Lesions
	2.1	 Introduction
	2.2	 Inflammatory Breast Lesions
	2.3	 Benign Breast Lesions and Benign Breast Tumors
	2.4	 Epithelial Proliferative Lesions
	2.5	 Malignant Breast Tumors
		2.5.1	 Carcinoma in Situ
		2.5.2	 Papillary Carcinoma
		2.5.3	 Invasive Carcinoma
	References
3: Aspiration Techniques
	3.1	 Introduction
	3.2	 Role of Breast FNAC in the Clinical Practice
	3.3	 Breast FNAC Procedure
		3.3.1	 Equipment
		3.3.2	 Lesion Localization
			3.3.2.1	 Palpation
			3.3.2.2	 Ultrasound-Guided FNAC
		3.3.3	 Aspiration Procedure
		3.3.4	 Preparation of Smears
		3.3.5	 Fixation and Staining
		3.3.6	 Reporting of the Results
	3.4	 Clues to Enhance Diagnostic Accuracy
	3.5	 Complications of Breast FNAC
	References
4: Liquid-Based Cytology and Cell Block in Breast Lesions
	4.1	 Liquid-Based Cytology
		4.1.1	 Advantages
		4.1.2	 Disadvantages
	4.2	 Cell Block
	4.3	 Summary
	References
5: Breast Fine Needle Aspiration Cytology: Introduction to the Yokohama Classification
	5.1	 Insufficient Category
		5.1.1	 Definition
		5.1.2	 Risk of Malignancy (ROM)
		5.1.3	 Discussion
	5.2	 Benign Category
		5.2.1	 Definition
		5.2.2	 Risk of Malignancy (ROM)
		5.2.3	 Discussion
	5.3	 Atypical Category
		5.3.1	 Definition
		5.3.2	 Risk of Malignancy (ROM)
		5.3.3	 Discussion
	5.4	 Suspicious Category
		5.4.1	 Definition
		5.4.2	 Risk of Malignancy (ROM)
		5.4.3	 Discussion
	5.5	 Malignant Category
		5.5.1	 Definition
		5.5.2	 Risk of Malignancy (ROM)
		5.5.3	 Discussion
	References
6: Inflammatory Lesions of the Breast
	6.1	 Clinical Findings
	6.2	 Breast Abscess and Acute Mastitis
	6.3	 Subareolar Abscess
	6.4	 Duct Ectasia
	6.5	 Chronic Granulomatous Mastitis
	6.6	 Diabetic Mastopathy
	6.7	 Fat Necrosis
	6.8	 Summary
	References
7: Fibrocystic Changes and Cysts
	7.1	 Non-proliferative Lesions
		7.1.1	 Cysts
		7.1.2	 Apocrine Metaplasia
		7.1.3	 Fibrosis
		7.1.4	 Reporting Non-proliferative Lesions
	7.2	 Proliferative Lesions
		7.2.1	 Adenosis
			7.2.1.1	 Clinical and Radiology
			7.2.1.2	 Cytology
			7.2.1.3	 Histology
		7.2.2	 Radial Scar or Complex Sclerosing Lesion
			7.2.2.1	 Clinical and Radiology
			7.2.2.2	 Cytology
			7.2.2.3	 Histology
		7.2.3	 Epithelial Hyperplasia/Usual Ductal Hyperplasia
			7.2.3.1	 Clinical and Radiology
			7.2.3.2	 Cytology
			7.2.3.3	 Histology
		7.2.4	 Columnar Cell Changes
			7.2.4.1	 Clinical and Radiology
			7.2.4.2	 Cytology
			7.2.4.3	 Histology
		7.2.5	 Reporting Proliferative Lesions
	7.3	 Summary
	References
8: Fibroadenoma
	8.1	 Clinical, Radiological, and Epidemiological Findings
	8.2	 Cytologic Findings
	8.3	 Differential Diagnosis
		8.3.1	 Fibrocystic Changes
		8.3.2	 Pseudoangiomatous Stromal Hyperplasia (PASH)
		8.3.3	 Mucocele-Like Lesions
		8.3.4	 Phyllodes Tumors
		8.3.5	 Hamartoma
		8.3.6	 Tubular Adenoma
		8.3.7	 Adenomyoepithelioma
		8.3.8	 Pleomorphic Adenoma
		8.3.9	 Papillary Lesions
		8.3.10	 Carcinoma
	8.4	 Histologic Correlations
	8.5	 Management
	References
9: Other Fibroepithelial Lesions
	9.1	 Phyllodes Tumors
		9.1.1	 Cytologic Grading in Phyllodes Tumors
		9.1.2	 Differential Diagnosis
	9.2	 Hamartoma
		9.2.1	 Clinical and Epidemiological Findings
		9.2.2	 Cytologic Findings
		9.2.3	 Differential Diagnosis
		9.2.4	 Management
	9.3	 Pseudoangiomatous Stromal Hyperplasia (PASH)
		9.3.1	 Clinical and Epidemiological Findings
		9.3.2	 Cytologic Findings
		9.3.3	 Differential Diagnosis
		9.3.4	 Management
	References
10: Cytology of Epithelial Proliferative Lesions and High-Grade Ductal Carcinoma In Situ
	10.1	 Introduction
	10.2	 Non-Proliferative Breast Disease
		10.2.1	 Clinical and Epidemiological Findings
		10.2.2	 Cytologic Findings
		10.2.3	 Histologic Correlations
	10.3	 Benign Breast Proliferative Lesions
		10.3.1	 Moderate and Florid Epithelial Hyperplasia
			10.3.1.1	 Clinical and Epidemiological Findings
			10.3.1.2	 Cytologic Findings
			10.3.1.3	 Histologic Correlations
		10.3.2	 Sclerosing Adenosis
			10.3.2.1	 Clinical and Epidemiological Findings
			10.3.2.2	 Cytologic Findings
			10.3.2.3	 Histologic Correlations
		10.3.3	 Columnar Cell Changes
			10.3.3.1	 Clinical and Epidemiological Findings
			10.3.3.2	 Cytologic Findings
			10.3.3.3	 Histologic Correlations
	10.4	 Atypical Epithelial Proliferations
		10.4.1	 Atypical Ductal Hyperplasia
			10.4.1.1	 Clinical and Epidemiological Findings
			10.4.1.2	 Cytologic Findings
			10.4.1.3	 Differential Diagnosis
			10.4.1.4	 Histologic Correlations
			10.4.1.5	 Management
		10.4.2	 Ductal Carcinoma In Situ, Low Grade
			10.4.2.1	 Clinical and Epidemiological Findings
			10.4.2.2	 Cytologic Findings
			10.4.2.3	 Differential Diagnosis
			10.4.2.4	 Histologic Correlations
			10.4.2.5	 Management
		10.4.3	 Lobular Neoplasia
			10.4.3.1	 Clinical and Epidemiological Findings
			10.4.3.2	 Cytologic Findings
			10.4.3.3	 Differential Diagnosis
			10.4.3.4	 Histologic Correlations
			10.4.3.5	 Management of the Results
	10.5	 Ductal Carcinoma In Situ, High Grade
		10.5.1	 Cytologic Findings
		10.5.2	 Differential Diagnosis
	References
11: Papillary Lesions of the Breast
	11.1	 Introduction
	11.2	 Intraductal Papilloma
		11.2.1	 Clinical and Epidemiological Findings
		11.2.2	 Cytologic Findings
		11.2.3	 Differential Diagnosis
			11.2.3.1	 Epithelial Hyperplasia
			11.2.3.2	 Atypical Epithelial Hyperplasia
			11.2.3.3	 Columnar Cell Changes
			11.2.3.4	 Radial Scar
			11.2.3.5	 Fibroadenoma
			11.2.3.6	 Nipple Adenoma and Tubular Adenoma
		11.2.4	 Histologic Correlations
	11.3	 Papillary DCIS
		11.3.1	 Clinical and Epidemiological Findings
		11.3.2	 Cytological Findings
		11.3.3	 Differential Diagnosis
			11.3.3.1	 Benign Papillary Lesions
			11.3.3.2	 Other Types of Low-Grade DCIS
			11.3.3.3	 Invasive Low-Grade Ductal Carcinoma
		11.3.4	 Histologic Correlations
	11.4	 Solid Papillary Carcinoma
		11.4.1	 Clinical and Epidemiological Findings
		11.4.2	 Cytologic Findings
		11.4.3	 Differential Diagnosis
		11.4.4	 Histologic Correlations
	11.5	 Encapsulated Papillary Carcinoma
		11.5.1	 Clinical and Epidemiological Findings
		11.5.2	 Cytologic Findings
		11.5.3	 Differential Diagnosis
			11.5.3.1	 Benign Papillary Lesions
			11.5.3.2	 High-Grade DCIS
			11.5.3.3	 Carcinoma of Other Types
		11.5.4	 Histologic Correlations
	References
12: Mucinous Lesions
	12.1	 Introduction
	12.2	 Mucocele-Like Lesions
		12.2.1	 Clinical and Epidemiological Findings
		12.2.2	 Cytologic Findings
		12.2.3	 Histologic Correlations
		12.2.4	 Management
		12.2.5	 Reporting
	12.3	 Mucinous Carcinoma
		12.3.1	 Clinical and Epidemiological Findings
		12.3.2	 Cytologic Findings
		12.3.3	 Histologic Correlations
		12.3.4	 Management
		12.3.5	 Reporting
	12.4	 Mucinous Cystadenocarcinoma
		12.4.1	 Clinical and Epidemiological Findings
		12.4.2	 Cytologic Findings
		12.4.3	 Histologic Correlations
		12.4.4	 Management
	12.5	 Mucinous Papillary Neoplasms
		12.5.1	 Clinical and Epidemiological Findings
		12.5.2	 Cytologic Findings
		12.5.3	 Histologic Correlations
		12.5.4	 Management
		12.5.5	 Reporting
	12.6	 Invasive Lobular Carcinoma with Extracellular Mucin
	12.7	 Differential Diagnosis
		12.7.1	 Myxoid Fibroadenoma
		12.7.2	 Fibrocystic Changes with Luminal Mucin
		12.7.3	 Polyacrylamide Gel Injection
	References
13: Carcinoma and Variants
	13.1	 Clinical Findings
	13.2	 Radiologic Findings
	13.3	 Pathologic Findings
		13.3.1 Gross Findings
		13.3.2 Histologic Findings
	13.4	 Cytologic Findings
		13.4.1 General Findings
		13.4.2 Invasive Breast Carcinoma of no Special Type (Ductal)
		13.4.3 Invasive Lobular Carcinoma
		13.4.4 Tubular Carcinoma
		13.4.5 Invasive Cribriform Carcinoma
		13.4.6 Mucinous Carcinoma
		13.4.7 Invasive Carcinoma NST with Medullary Pattern
		13.4.8 Invasive Micropapillary Carcinoma
		13.4.9 Metaplastic Carcinoma
		13.4.10 Apocrine Carcinoma
		13.4.11 Papillary Carcinoma
		13.4.12 Secretory Carcinoma
		13.4.13 Acinic Cell Carcinoma
		13.4.14 Glycogen-Rich Carcinoma
		13.4.15 Lipid-Rich Carcinoma
		13.4.16 Adenoid Cystic Carcinoma
		13.4.17 Paget Disease
	References
14: Other Uncommon Lesions
	14.1	 Primary Breast Lymphoma
		14.1.1	 Clinical Finding
		14.1.2	 Cytologic Findings
			14.1.2.1	 Diffuse Large B Cell Lymphoma
			14.1.2.2	 Burkitt Lymphoma
			14.1.2.3	 Breast Implant-Associated Anaplastic Large Cell Lymphoma
	14.2	 Metastases to the Breast
		14.2.1	 Clinical Finding
		14.2.2	 Cytologic Findings
	14.3	 Summary
	References
15: Assessment of Axillary Nodes
	15.1	 Background
	15.2	 Sentinel Node Biopsy
	15.3	 Normal Versus Abnormal Nodes: Imaging Appearances
	15.4	 Ultrasound-Guided Needle Biopsy of Axillary Nodes
	15.5	 Fine Needle Aspiration Cytology
	15.6	 Accuracy of the Preoperative Ultrasound-Guided Needle Biopsy
	References
16: Special Ancillary Techniques: Immunohistochemistry
	16.1	 Markers Useful for Differentiating Between Benign and Malignant Aspirates
	16.2	 Markers Useful for Classification of Breast Cancers
	16.3	 Markers Useful for Prognostication and Prediction to Response to Treatment
	16.4	 Markers Useful for Correlation with Response to Treatment and Outcome
	References
17: Molecular Studies and Artificial Intelligence
	17.1	 Introduction
	17.2	 Molecular Classification of Breast Cancer
	17.3	 Molecular Studies on FNAB from Primary Breast Tumors
	17.4	 Molecular Studies on FNAB from Metastatic Breast Tumors
	17.5	 Molecular Studies on FNAB Material Used for Frozen Tissue Banking of Breast Cancer
	17.6	 Artificial Intelligence in Cytology
	References
18: Comparison of Aspiration and Core Needle Biopsy
	18.1	 Introduction
	18.2	 Comparison Between FNAC and Core Biopsy
	18.3	 Non-palpable, Screen-Detected Calcifications
	18.4	 Low-Grade Malignancy and Borderline Lesions
	18.5	 Ductal Carcinoma In Situ and Invasive Carcinoma
	18.6	 Papillary Lesions
	18.7	 Fibroepithelial Lesions
	18.8	 Summary
	References
19: Future Directions
	References
Index