Breast cytology

Cytology of the mammary gland is a diagnostic method based on the assessment and study of cellular material. Let's consider the methodology, indications, interpretation of results and other nuances of diagnostics.

As a rule, cytology is used in combination with other clinical methods, which are leading in modern diagnostics of mammary gland pathologies. The study is valued for its simplicity, easy repeatability and speed. This makes it possible to use it to study the dynamics of morphological changes during illness and treatment. The method does not require large financial costs, so it can be used for morphological verification in a hospital setting or for preventive examinations and monitoring the condition of people at risk.

The material for analysis includes punctures of tumor-like neoplasms, regional lymph nodes, prints and scrapings from the damaged surface of the nipple, various seals, secretions, prints from pieces of tissue and cut surfaces. Experience in using the analysis allows us to determine with high accuracy the presence of a malignant neoplasm, the tissue affiliation of the tumor and the degree of its differentiation.

But the cytological conclusion always ends with the formulation of the preoperative diagnosis, which serves as the basis for developing the treatment tactics. For an adequate assessment, the cytologist uses such clinical data as: age, sex of the patient, tumor localization, phase of the menstrual cycle, where the material for the study was taken from, the therapy used (nature, dosage). The effectiveness of the technique also depends on how the material was obtained and how it was processed.

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Indications for the procedure

The reliability of cytological diagnostics is considered to be the highest and is 90-97%. Let's consider the main indications for its implementation:

• Determining the nature of the neoplasm (malignant, benign).
• Clarification of the stage of tumor spread.
• Establishing the degree of tumor differentiation for its classification (change in shape, cell structure).
• Obtaining data on background changes (formation of granulomas and polyps, chronic inflammation).
• Prognosis of the disease.
• Additional study of bacterial flora.

As a rule, the analysis is carried out during a comprehensive examination, along with other diagnostic methods. Ultrasound, mammography, and pneumocystography are used to detect pathologies of the mammary glands. If seals, nodules, or any other neoplasms are detected, a puncture is taken. If changes in the structure of the skin and color of the gland, discharge from the nipple are detected during a visual examination, then a puncture is mandatory, since there is a suspicion of a malignant lesion. The criterion for the veracity of cytology is the results of comparison with a planned histological study.

Methodology of implementation

Many methods are used to detect various pathologies of the mammary gland. Let us consider the method of conducting a cytological study, which is based on microscopic examination and evaluation of cellular material obtained from the site of pathology. This analysis is related to oncomorphology, but it should not be opposed to histology.

Benefits of diagnostics:

• Harmlessness.
• Rapidity.
• Accessibility and simplicity.
• Possibility of multiple studies.
• Using a small amount of material for microscopic examination

The main goal is to make a correct diagnosis, which will avoid surgical intervention when performing a biopsy and will make it possible to develop an effective treatment plan.

The following may serve as material for research:

• A scraping from breast tissue or a tumor removed during surgery.
• Puncture of mammary glands.
• Material from erosive surfaces.
• Discharge from the nipple.
• Biopsy prints.

It is extremely important to obtain complete material. It should be taken from the lesion, not the surrounding tissues.

1. Puncture

It is performed in a clinical laboratory or procedure room. It is performed under X-ray control, ultrasound or CT. This is necessary to control the position of the needle. Before the puncture, the area to be used is palpated well to determine mobility, connection with surrounding tissues and selection of optimal fixation. The tissues are fixed with fingers and an aspiration needle is guided. Upon reaching the focus of pathology, a couple of sharp suction movements are made with a syringe to collect material.

The contents of the needle are blown onto a glass slide or into a container with a solution. If liquid appears during the puncture, a test tube is placed under the needle and it is collected. After the liquid is removed, the gland tissues are carefully palpated to exclude residual masses, which may be cystic contents.

2. Biopsy

Cytological preparations may be made from tissues obtained using this method. The imprint is made by moving the biopsy material with a needle on glass, while avoiding injury to the tissues taken.

3. Surgical material

Using a scalpel, an incision is made in the lymph node, tumor or lump. The material is obtained by applying a glass to the incision. If the tissue consistency is dense, which does not allow an imprint to be made, then a scraping is made from the surface of the tumor incision.

4. Discharge from the mammary gland

A drop of discharge is applied to the glass and a smear is prepared. If there is little discharge, then to obtain a smear, the area around the nipple is pressed using squeezing movements.

5. Smears-imprints from eroded surfaces

I apply glass to the lesion, on which cellular elements of the discharge remain. You can also use a cotton swab. All the obtained material is sent to the laboratory immediately after collection.

Decoding of breast cytology

Diagnostic testing is important in making a diagnosis and developing a treatment plan. Its effectiveness largely depends on the method of conducting and decoding. Cytology of the mammary gland is one of the most popular and truthful methods of detecting pathologies. Having received the results, patients should understand that the final conclusion can only be made by a doctor who operates with symptoms, test results, images and other data.

Interpretation of cytology results is a complex process. Let's look at the main analysis interpretations:

1. Incomplete result - this conclusion indicates the need for additional research. Most likely, the difficulties arose due to the small volume of cellular material. With such a conclusion, the doctor recommends a repeat procedure.
2. Norm - tissues taken for analysis contain cells that do not have pathological signs. Additional bodies or inclusions are not detected.
3. Benign cells - no signs typical of cancer cells.
4. Noncancerous cells – abnormal clusters of atypical cells and compounds were found in the tissues examined. However, they are not of tumor origin. Such results may indicate cysts, mastitis, or other types of inflammatory processes.
5. Malignant neoplasms – confirm the presence of a cancerous tumor in the mammary gland. The transcript should contain additional information about the stage, boundaries and localization of the tumor. Tumor signs are obvious, characteristic clusters are present.

It is not recommended to rely entirely on the information received, since even in a cytological report errors are quite likely. If the doctor has doubts about the veracity of the results, then another sample collection is carried out for study.

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Liquid-based cytology of the mammary gland

One of the leading methods in determining pathological processes in the body is morphological. It is based on the study of cytological and histological material. Liquid cytology of the mammary gland is considered the best method for processing tissue material. Preparations prepared on a cytocentrifuge have a single-layer structure and are evenly distributed over a certain surface. This allows you to save expensive reagents when conducting immunocytochemical studies. And the results of such diagnostics are easy to interpret.

The cytologist examines the material, taking into account clinical and anamnestic data, ultrasound, CT and mammography results. Tumor punctures, nipple discharge, and pathology foci prints are suitable for examination. In addition to liquid cytology, fixation and staining of materials are used.

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Cytology of breast cysts

One of the most common diseases of the mammary gland is a cyst. Most often, the pathology appears in patients aged 35-50. The cause of the disease is hormonal imbalances. Cysts can be unilateral and bilateral, single and multiple. Diagnostics are resorted to when appropriate clinical manifestations occur. The tissues of the glands become dense and rough, pain and discharge from the nipples appear. Palpation reveals a small formation of dense elastic consistency.

Cytology for breast cysts is performed with appropriate indications, which are obtained using mammography, ultrasound and CT. Particular attention is paid to differential diagnostics with cancer and fibroadenoma. Puncture is used to collect material. This is explained by the fact that the cyst is a fluid-filled sac. During the examination, it is punctured with a special thin needle, and the liquid contents are sent for cytological examination.

The main objective of the analysis is to identify atypical, i.e. cancer cells. If there are no conditions for safe material collection, the manipulation may affect further treatment, or other diagnostic procedures have established the presence of metastasis, then puncture cytology is not performed.

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Cytology in fibroadenoma of the mammary gland

One of the types of tumor lesions of the mammary gland is fibroadenoma. This neoplasm is related to leaf-shaped tumors. Smears used for cytology in fibroadenoma of the mammary gland are represented by cubic epithelium and connective tissue elements of the stroma. Fibroadenoma is quite common, but leaf-shaped tumors do not exceed 2% of all fibroadenomas.

Such a tumor has the potential to transform into a sarcoma due to malignant changes in the stroma. And the presence of an epithelial component may indicate the development of carcinoma. Most often, the neoplasm is localized in the upper and central squares of the gland. In this case, there is no discharge from the nipples or metastases in the lymph nodes.

The following variants of leaf-shaped tumor are distinguished according to cytology:

• With the presence of epithelial and connective tissue cellular elements.
• With a predominance of epithelial components and a scanty amount of connective tissue component.
• With a predominance of cellular elements similar in content to the cystic cavity.
• With scant epithelial or stromal component.

An accurate cytological result of fibroadenoma, i.e. a benign form of leaf-shaped tumor, is possible only with the first option.

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Cytology in breast cancer

Breast cancer is characterized by cellular and nuclear polymorphism, which makes the cytological diagnosis 90% reliable. Let's consider the features of cytology in breast cancer and the types of cancerous lesions:

1. Colloid cancer has densely located cells in clusters and mucus production in the cytoplasm or in the form of benzoic stained masses, i.e. extracellularly.
2. Papillary cancer has a pronounced polymorphism of cellular elements, rough with uneven contours and hyperchromic nuclei.
3. Low-differentiation cancer – cytology is characterized by a monomorphic picture. The cells are rounded, and the nuclei occupy the central part of the cell. Sometimes the picture is similar to the cytogram of malignant lymphoma.
4. Paget's disease - most cells are indistinguishable from poorly differentiated or moderately differentiated cancer. Large, clear cells are present.
5. Cancer with squamous metaplasia - there are polymorphic cells that are located separately with abundant homogeneous cytoplasm and hyperchromatic nuclei.

For the study, punctures of tumor formations, punctures of regional lymph nodes, secretions and scrapings from the nipple and erosive surfaces, contents of cystic cavities, tumor or lymph node imprints are used.

The main principles of cytological diagnostics are:

• The difference in cellular composition in pathology and normal conditions.
• Evaluation of the cell population.
• Application of pathological anatomical basis.

Each study should end with a detailed conclusion. Diagnostic criteria are based on the morphology of the nucleus and cell, let's look at them in more detail:

• Cell

It has increased or giant dimensions, which significantly complicates cytology. Similar is observed in lobular, mastitis-like and tubular cancer. There is a change in polymorphism and shape of cell elements. The state of the nucleus and cytoplasm is disturbed.

• Core

It has an increased size, is lumpy, and has uneven contours. Polymorphism, hyperchromia, and an uneven chromatin pattern are observed. In rare cases, cell division figures are detected.

• Nucleolus

It has an irregular shape and is enlarged. The affected cell has many more nucleoli than the healthy one.

The main criterion for the reliability of a cytological study is a comparison of the results obtained with histology.

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Cytology of mammary gland discharge

The study of the cellular and bacterial components of the secreted fluid is called cytology of secretions from the mammary glands. This method involves taking a smear or imprint of the secretion from each nipple with subsequent sowing on a nutrient medium.

The causes of discharge can be both pathological, indicating a certain disease, and natural. Thus, in older women, ectasia of the milk ducts with signs of an inflammatory process is observed. Discharge can be caused by intraductal papilloma, galactorrhea, traumatic lesions, abscess, fibrous mastopathy, malignant neoplasms or pregnancy.

Cytology of the mammary gland allows to recognize the nature of the discharge, identify its cause and prescribe effective treatment. Only a qualified doctor should conduct diagnostics in a laboratory setting. The conclusion is made based on the results of the analysis, various diagnostic methods, palpation and individual characteristics of the patient's body.

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