This document provides information on fine needle aspiration cytology (FNAC) findings for different types of breast cancers and lesions. It describes the typical cellular appearance and characteristics seen on FNAC for normal breast tissue, ductal carcinoma, lobular carcinoma, medullary carcinoma, mucinous carcinoma, tubular carcinoma, and metaplastic carcinoma. It also outlines the Scarff-Bloom-Richardson grading system used to assess breast cancer prognosis based on histopathological analysis of tumor cells and tissue structure.

1. FNAC OF BREAST
CANCER
DR SAURAV

2. NORMAL BREAST FNAC
• Usually yields scanty cellularity.
• Following cells can be seen in FNAC of a nonneoplastic breast
 DUCTAL CELLS –
Cells are small round with monomorphic
nuclei.
nuclear membrane is regular with
homogeneous chromatin.

3.  MYOEPITHELIAL CELLS –
These are elongated spindle-shaped naked cells.
presence of such cells is hallmark of benign nature
of lesion.
 APOCRINE CELLS –
These are large cells having abundant granular
cytoplasm with central to eccentric monomorphic
round nuclei.
These cells are usually present in fibrocystic
disease or fibroadenoma.

4.  FOAM CELLS –
These cells have abundant vacuolated cytoplasm
and centrally placed monomorphic round nucleus.
phagocytosed material may be found in the
cytoplasm
presence of foam cells usually indicates cystic
degeneration.

5. DUCTAL CARCINOMA
 FNAC FINDINGS
More or less cell rich smears
Single population of epithelial cells; no
myoepithelial cells, no single bare bipolar nuclei
Variable loss of cell cohesion-irregular clusters and
single cells
Single epithelial cells with intact cytoplasm

6. Moderate to severe nuclear
atypia;enlargement,pleomorphism,irregular
nuclear membrane and chromatin
Fibroblasts and fragments of collagen associated
with atypical cells
Intracytoplasmic neolumina in some cases
Necrosis unusual, more suggestive of DCIS.

7. Problems and differential diagnosis
 Representative sampling
 Smearing artifacts
 Carcinoma with small cells
 Fibrosclerotic lesions
In situ and low grade carcinoma
Nuclear atypia in other lesions
Gynaecomastia
Metastatic carcinoma

8. Ductal carcinoma NOS,low grade

9. Ductal carcinoma NOS,intermediate grade

10. Invasive duct carcinoma NOS,high grade

11. LOBULAR CARCINOMA
 Usual findings
A variable, often poor cell yield
 Cells single and in small clusters, single files
characteristic
Scanty cytoplasm; many naked nuclei; nuclear
moulding in cell clusters
Small hyperchromatic nuclei of relatively uniform
size.

12. Irregularity of nuclear shape
Intracytoplasmic lumina/mucin vacuoles/signet
ring cells
Few if any naked bipolar nuclei
Traumatised cell pattern

13. Problems and differential diagnosis
Sparse cellularity
Resemblance to non-neoplastic breast tissue in
low power
Component of benign epithelium
Lobular hyperplasia in pregnancy and lactation
Distinction from low-grade ductal carcinoma
Intracytoplasmic lumina in other lesions

14. Lobular carcinoma (classic type)

15. Infiltrating lobular carcinoma,classic type

16. Lobular carcinoma,alveolar type

17. MEDULLARY CARCINOMA
– Abundant dissociated cells along with syncytial
clusters of malignant cells
– Round to oval large cells with moderate nuclear
pleomorphism
– Large prominent nucleoli
– Lymphocytes and plasma cells

18. Problems and differential diagnosis
Metastatic malignancy to axillary nodes
Malignant lymphoma
High grade DCIS (comedocarcinoma)

19. Medullary carcinoma

20. MUCINOUS CARCINOMA
Large amount of mucinous material
Floating malignant cells in the pool of mucin
Cells with abundant cytoplasm
Mild to moderately pleomorphic nuclei
Bland nuclear chromatin
“Chicken wire” blood vessels are often present in
smears of mucinous carcinoma

21. Problems and differential diagnosis
Lack of nuclear pleomorphism
Mucinous DCIS
Mucinous fibroadenoma
Myxoid stromal matrix resembling mucin
Metastatic carcinoma
Hemorrhage and necrosis induced by FNB
Ultrasound gel

22. Colloid carcinoma

23. Colloid carcinoma

24. TUBULAR CARCINOMA
• Usual findings:
 Moderately cellular smears
 Cells predominantly in cohesive clusters
 Epithelial fragments with an angular or tubular shape
 Relatively uniform, mildly to moderately atypical
epithelial cells
 Single bipolar nuclei of benign type often present in
small numbers
 Fibroblastic cells; fragments of fibromyxoid or elastotic
stroma.

25. Problems and differential diagnosis
Minor deviation from the benign pattern
Mixed tubular and usual ductal carcinoma
Complex sclerosing lesion/radial scar,adenosis
Fibroadenoma

26. Tubular carcinoma

27. Tubular carcinoma

28. METAPLASIC CARCINOMA
– Predominant cell component is other than
glandular or epithelial
– Population of spindle cells, multinucleated giant
cells or squamous cells may be seen.

29. Scarff-Bloom-Richardson
(SBR) Grade in Breast Cancer
– Histologic grading system for breast cancer
– The cells and tissue structure of the breast cancer
are examined histopathologically to determine
how aggressive the cancer is
– Correlates well with prognosis
– Adopted by World Health Organization in 1968
– Also referred to as Nottingham modification

30. Scarff-Bloom-Richardson
(SBR) Grading
• Tubule Formation
– Majority of tumor (>75%) – 1 point
– Moderate degree (10-75%) – 2 points
– Little or none (<10%) – 3 points
• Nuclear pleomorphism (compare to adjacent normal epithelium)
– Small, regular uniform cells – 1 point
– Moderately increased size and variability – 2 points
– Marked variation – 3 points
• Mitotic Count (must adjust for microscope field)
– Low – 1 point
– Moderate – 2 points
– High – 3 point

31. Scarff-Bloom-Richardson (SBR) Grade
Grade 1
Tubule
Formation
Nuclear
Pleomorphism
Mitotic
Count
Grade 2
Grade 3

32. Overall Grade is Sum of Scores
Grade 1 – well differentiated
– 3 to 5 points
Grade 2 – moderately differentiated
– 6 to 7 points
Grade 3 – poorly differentiated
– 8 to 9 points