Papillary lesions of breast - An introspect of cytomorphological features

Background : True papillary lesions of the breast have a significantly high error rate on fine needle aspiration cytology (FNAC), as many other nonpapillary breast lesions exhibit overlapping features on cytosmears. Aim : To evaluate the utility of individual morphological features in offering a more precise cytodiagnosis in papillary lesions of the breast. Materials and Methods : Cytology smears reported as papillary lesions on nipple discharge / FNAC and histopathology over a period of two years were studied and correlated. A subjective assessment of morphological features, namely, the cellular yield, presence of three-dimensional papillary clusters, stromal bare nuclei, presence of cyst macrophages and cellular atypia was carried out on cytosmears. Results : Fourteen cases of papillary lesions were identified. Thirty-six per cent of the cases were found to be true positive, 43 false negative and 21 false positive with a sensitivity of 42 for papillary lesions. Eight of nine papillary lesions showed cyst macrophages. Stromal bare nuclei were seen in three of four malignant papillary lesions. However, the number of stromal bare nuclei was less compared to benign lesions. None of the malignant nonpapillary lesions showed stromal bare nuclei. Conclusions : Cytomorphological features alone are inadequate for the precise diagnosis of papillary lesions of the breast.