Memenin Özelleşmiş Tipteki Karsinomlarında İnce İğne Aspirasyonu Bulguları: 60 Olgunun Sito-histopatolojik Korelasyonları

Öz

Amaç: Bu çalışmanın amacı, meme karsinomlarının spesifik subtiplerinin (lobüler, papiller, medüller, müsinöz, tubuler ve diğer), ince iğne aspirasyonu sitopatolojisi (İİAS) ile tanısındaki performansımızı değerlendirmektir.

Yöntem: Bölümümüzde, 2006-2011 yıllarında sitopatolojik ve histopatolojik incelemeleri yapılan, spesifik subtipteki meme karsinomu olgularının İİAS sonuçları histopatolojik tanılarıyla karşılaştırıldı. İİAS tanıları, benign, atipik, kuşkulu, malign ve temsil edici olmayan olarak gruplandı. Kesin ve total sensitivite oranları, atipik (gri-zon) ve yetersiz İİAS sonuçlarının, histopatolojik subtip ile korelasyonu araştırıldı.

Bulgular: Sito-histopatolojik korelasyonu yapılan toplam 60 olgunun, 59 (%98,3)’u kadın, 1(%1,7)’i erkek hasta olup; yaş aralığı 34-83 yıl arasındaydı. Genel ortalama yaş 58,5(±13,3) iken; medüller karsinom olgularında anlamlı derecede (49) düşüktü. Sitopatolojik olarak, olguların 1(%1,7)’i benign (C2) ve 5(%8,3)’i atipik (C3) tanısı alırken; 10(%16,7) olgu malignite kuşkulu (C4) ve 37(%61,7) olgu malign (C5) olarak değerlendirilmiş; 7(%11,7)’si ise tanı için yetersiz bulunmuştu. Histopatolojik spesifik subtiplere göre, 36(%60,0) invaziv lobüler, 8 papiller, 7 medüller, 5 müsinöz, 3 tubuler ve 1 adenoid kistik karsinom bulunmaktaydı. İnvaziv lobüler subtipteki karsinomlar, daha düşük (%52,8 kesin (C5) ve %69,5 total (C5+C4) sensitivite oranlarına sahipti. Total sensitivite oranları, papiller, medüller, müsinöz ve tubuler karsinomlarda %100’dü. Gri-zon olguları (%13,9) ve yanlış negatiflik (%2,8) invaziv lobüler karsinomlarda daha yüksek iken; tubuler karsinomlarda daha yüksek yetersizlik (%33,3) oranı bulundu.

Sonuç: Memenin spesifik subtipteki karsinomlarının İİAS ile preoperatif değerlendirmesinde, invaziv lobüler ve tubuler karsinom subtipleri, İİAS’nin tanısal gücünü sınırlamaktadır. Meme hastalıklarına yaklaşımın üçlü sacayağı (klinik, radyolojik ve patolojik) gerektirmesi nedeniyle, özellikle spesifik subtipteki meme karsinomu olgularını değerlendirirken, İİAS’nin bu konudaki sınırlılıklarının ilgili uzmanlıklar için farkındalığı, yanlış-negatif ve yanlış- pozitif sonuçların azaltılması açısından önemlidir. 

Anahtar Kelimeler

• Meme,ince iğne aspirasyonu,spesifiye,karsinom,sitopatoloji

Fine Needle Aspiration Findings Of Specified Carcinomas Of The Breast: 60 Cases With Cyto-histopathologic Correlations

Öz

Objectives: Fine needle aspiration (FNA) continues to be an acceptable and reliable procedure for the preoperative diagnosis of breast lesions, particularly. The purpose of this study is to evaluate our performance with FNA cytopathology (FNAC) in specific subtypes of (lobular, papillary, medullary, mucinous, tubular and other) breast carcinomas.

Methods: FNAC results of specified carcinomas of breast, cyto-diagnosed and subsequently biopsied in 2006-2011 were compared with final histopathological evaluation. The results of FNAC were interpreted as benign, atypical, suspicious, malignant and non-representative. The absolute and complete sensitivity rates, underestimation of malignancy rate and inadequacy rate of FNAC were correlated with histopathologic subtype.

Results: Of cyto-histopathologically correlated 60 cases, 59 (98.3%) were females and 1(1.7%) was a male. Age range was 34-83 years with a mean value of 58.5(±13.3). Mean age was significantly lower (49) in medullary carcinoma patients. Of cases, 1(1.7%) was diagnosed as benign (C2), 5(8.3%) were atypical (C3), 10(16.7%) were suspicious (C4), 37(61.7%) were malignant (C5) and 7(11.7%) were inadequate (C1) by cytopathology. Of specified histopathologic subtypes, 36(60.0%) lobular, 8 papillary, 7 medullary, 5 mucinous, 3 tubular and 1 adenoid cystic carcinomas were included. Invasive lobular-type carcinomas had lower (52.8% absolute (C5)); 69.5% complete (C5+C4) sensitivity rates. The complete sensitivity rate was 100% in papillary, medullary, mucinous and tubular carcinomas. The underestimation of malignancy rate (13.9%) and false negativity (2.8%) was higher in lobular carcinomas while tubular carcinomas showed a higher inadequacy rate (33.3%).

Conclusion: For FNAC of the breast in the preoperative diagnosis of specified breast carcinomas, lobular and tubular carcinoma subtypes limit cytodiagnostic yield of FNAC. As management of breast diseases necessitates triple approach (clinical, radiological, pathological), an awareness of the FNAC limitations by all specialists is important, especially when dealing with specified breast carcinomas to decrease false-negative and false-positive results. 

Anahtar Kelimeler

• Breast,fine needle aspiration,specified,carcinoma,cytopathology

Kaynakça

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