Giorgio Gherardi, M.D., Cristina Marveggio, B.D., Stefania Rossi, M.D.
The distinction of florid hyperplasia without atypia (FH), atypical ductal and lobular hyperplasia (ADH and ALH), ductal carcinoma in situ (DCIS) and low nuclear grade invasive ductal carcinoma (IDC) on fine-needle aspirates (FNA) is sometimes very difficult or impossible due to a significant overlap of cytomorphologic features of these lesions- ( 1-5 ). Strict adherence to a standardized set of cytomorphologic criteria ( 6-10 ) may be helpful in the categorization of this group of borderline breast lesions but a reliable distinction of benign proliferations from premalignancy and malignancy is still impossible ( 11 ).
Several ancillary techniques have been used with the purpose of providing adjunctive and supplemental information that may potentially help refine the cytologic diagnosis in aspiration samples. Among these, DNA-ploidy analysis provides relevant data which may increase diagnostic accuracy: in fact, while DNA diploidy may be found either in benign and in malignant lesions, aneuploidy is strongly correlated to malignancy ( 11-18 ); moreover, combined evaluation of DNA ploidy and cell kinetics in diploid proliferations can help identify a group of lesions with a higher risk of being malignant ( 19 ).
The aim of the current study was to prospectively evaluate the diagnostic efficiency of the cytologic score developed by Masood et al ( 6 ) coupled to DNA digital image analysis to subclassify borderline epithelial proliferations in a considerable amount of breast aspirates.