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Biomedical subjects

D K Mulford

Publications and source records attributed to D K Mulford.

9 recordsLinked to original sources
PubMed1998

Breast carcinoma detection in women age 35 years and younger: mammography and diagnosis by fine-needle aspiration cytology.

BACKGROUND: Delays in breast carcinoma diagnosis may occur in young women due to a low index of suspicion. Fine-needle aspiration (FNA) is an ideal method for evaluating breast lesions in younger women. Mammographic and FNA findings, including nuclear grade, were studied to determine both the utility of FNA and the presence of unique cytologic features in women age < or = 35 years with breast carcinoma. METHODS: The cytopathology files were searched from 1984 to 1996 for FNA in women age < or = 35 years with breast carcinoma. The cytologic, mammographic, and clinical findings were reviewed in the 68 FNAs identified. A nuclear grade was assigned to each FNA. RESULTS: Thirteen patients were age < 30 years and 55 were age 31-35 years (range, 22-35 years; average, 31 years). The clinical and mammographic findings were carcinoma in 45 patients (66%) and fibroadenoma/benign in 23 patients (34%). FNA diagnoses were malignant/suspicious (86%), atypical (12%), and negative (1.4%). In 23 patients with unsuspected carcinoma, the FNA diagnosed or suggested malignancy in 22 of 23 patients (96%). The cytologic findings on review were variable. Many FNAs were cellular, with enlarged nuclei and prominent nucleoli. The FNAs predominantly were nuclear Grade 2 (47%) and 3 (47%); only 4 tumors were nuclear Grade 1 (6%). CONCLUSIONS: By detecting breast carcinoma in 23 patients with unsuspected carcinoma, this study demonstrates how breast FNA in young women can help avoid delays in diagnosis. The cytologic findings are striking for an increased incidence of high grade tumors.

Adult↗
PubMed1995

The cytopathology of proliferative breast disease. Comparison with features of ductal carcinoma in situ.

Epithelial hyperplasia, a component of proliferative breast disease (PBD), is a known risk factor for the development of breast carcinoma. To determine if criteria established for tissue biopsy could be used to more precisely define cytologic criteria for diagnosis of PBD, 37 breast fine-needle aspirates with biopsy diagnoses of PBD were studied. In cases with adequate cellularity, the following findings were consistently observed: (1) three-dimensional cell clusters with outlying myoepithelial cells, swirling intralumenal masses and peripheral, slit-like, irregular sublumens (65% of cases); (2) convoluted sheets of ductal epithelium with outlying myoepithelial cells and bulbous projections tethered to the ductal lining (29%); and (3) a background of discohesive small frayed groups of ductal cells (32%). Of the 15 cases that did not meet these criteria, most were paucicellular (87%), which suggested sampling error. Other cytologic features that were observed included: moderately increased cellularity (20 cases), moderate-to-marked nuclear overlap (14 cases), minimal nuclear atypia, and few single epithelial cells. Fifteen cases of confirmed ductal carcinoma in situ were studied for comparison. In these cases, cellularity, nuclear overlap, and atypia were increased, but swirling intralumenal masses, prominent myoepithelial cells and slit-like lumens were absent. In conclusion, the features of PBD established for tissue biopsy can be applied to cytologic specimens, and may provide useful clues to the diagnosis of epithelial hyperplasia in breast fine-needle aspiration specimens.

Adult↗
PubMed1994

Aspiration cytology of tubular carcinoma. Diagnostic features with mammographic correlation.

The detection of early, well-differentiated breast carcinoma is increasing because of mammographic screening. Because fine-needle aspiration cytology is often used as an adjunctive diagnostic tool with mammography, the authors defined the cytologic criteria for the diagnosis of this early breast carcinoma. Aspirates from 24 cases of biopsy-confirmed tubular carcinoma were studied. The majority of these carcinomas were detected by mammography and were nonpalpable masses. Mammographically, the lesions were .3-1.5 cm and were often described as ill-defined, spiculated densities. The cytologic diagnoses in these 24 cases were as follows: negative (4), fibrocystic changes (1), atypia (12), malignant (3), and fibroadenomas (4), (including 2 fibroadenomata with atypia and 1 suspicious for carcinoma). The aspiration cytology in all cases were reviewed, and the following characteristics were found in the 20 adequate smears: mild to moderate atypia, increased cellularity, angular epithelial clusters, and single epithelial cells ranging from few to numerous. Myoepithelial cells were prominent in 7 of 20 smears. The authors compared these features with aspiration cytology of 10 fibroadenomas, as this was a frequently suggested diagnosis. The fibroadenomas showed no significant atypia, minimal angular epithelial clusters, and rare single epithelial cells. Myoepithelial cells were prominent in all fibroadenomas. The authors concluded that the presence of angular epithelial groups and single epithelial cells, along with nuclear atypia, should warrant consideration of the diagnosis of tubular carcinoma.

Adenocarcinoma↗
PubMed1994

Breast fine-needle aspiration. A comparison of thin-layer and conventional preparation.

Two hundred forty-two breast fine-needle aspirates prepared by the Cytyc ThinPrep Processor were compared with aspirates prepared by the conventional smear method. Palpable and nonpalpable mammographic breast lesions were aspirated and the first half of the aspirate was submitted for conventional smears and the second half was rinsed into a proprietary fixative and loaded on the ThinPrep Processor for monolayer slide preparation. The matched pairs were diagnosed and analyzed separately in a double-blinded manner and later paired for comparison. Diagnoses correlated exactly in 62% of cases. The diagnosis of fibroadenoma was made in only 4 of 21 cases on ThinPrep (19% correlation). Semiquantitative analysis of several cytologic features indicated potential pitfalls for accurate diagnosis using the ThinPrep Processor. These included loss of background constituents (such as stroma and adipose tissue), decreased cellularity and single ductal epithelial cells, and decreased cytologic detail including size, shape and nuclear texture. The ThinPrep Processor may play a role in breast fine-needle aspiration, but further investigation is warranted before it is used as a sole preparatory method.

Adult↗
PubMedDate not supplied

Fine needle aspiration of mucinous (colloid) breast carcinoma. Nuclear grading and mammographic and cytologic findings.

OBJECTIVE: The clinical, mammographic and low grade cytologic features of mucinous carcinoma can make it difficult to diagnose by fine needle aspiration (FNA). Fine needle aspirates of mucinous carcinoma were reviewed with the mammographic findings to improve the diagnostic criteria and specificity for FNA. STUDY DESIGN: All aspirates were reviewed for cytologic criteria and cellularity, atypia and single epithelial cells (SEC). A nuclear grade was assigned to each aspirate. The mammographic findings were correlated with the FNA diagnoses. RESULTS: Forty-five patients with an aspirate and confirmed diagnosis of mucinous carcinoma were identified. The clinical impressions were: benign tissue (5), fibroadenoma (6) and cancer (32). The initial cytologic diagnoses were: adenocarcinoma (32), atypical/suspicious for cancer (11), insufficient (1) and negative (1). The cytologic findings showed smears with increased cellularity (35/45 cases) and minimal atypia. SEC with eccentrically located nuclei and eosinophilic cytoplasm were numerous. The assigned nuclear grade was as follows: grade 1, 16 cases; grade 2, 20 cases; and grade 3, 6 cases. Abundant mucin was present in Papanicolaou-stained slides in 23 cases; focal mucin was observed in 14 cases. The mammograms showed a smoothly outlined to lobulated mass with only slight irregularities identified. CONCLUSION: Mucinous carcinoma has a cytologic pattern that includes increased cellularity, with numerous single cells and abundant mucin. Although the mammographic findings may mimic a benign lesion, in the most patients a specific diagnosis of mucinous carcinoma can be made by FNA.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

Clinical trials of the CytoRich specimen-preparation device for cervical cytology. Preliminary results.

OBJECTIVE: To obtain preliminary data on the Roche CytoRich thin-layer system for the preparation of gynecologic cytology specimens, derived from a preclinical startup evaluation of the instrument and comparing the CytoRich method to conventional smears. STUDY DESIGN: At six different clinical sites, 286 pairs of conventional and CytoRich slides derived from the same patient sample were compared for the following: final Bethesda classification diagnosis, specimen adequacy and presence of microorganisms. RESULTS: The study showed agreement between the methods for an exact Bethesda diagnosis in 78% and agreement within one Bethesda diagnosis category in 95%. The CytoRich method diagnosed more cases of squamous intraepithelial lesion (SIL) than did the conventional method, and the differences in SIL detection were statistically significant. The CytoRich method identified similar numbers of cases with microorganisms as did the conventional smears, and the CytoRich system improved overall specimen adequacy as compared to the conventional method, with fewer cases of unsatisfactory and less-than-optimal smears. CONCLUSION: The CytoRich method may improve the overall sensitivity and specificity of the cervical cytology procedure. Clinical trials to verify these preliminary data are ongoing.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Benign versus malignant papillary neoplasms of the breast. Diagnostic clues in fine needle aspiration cytology.

Benign and malignant papillary lesions of the breast can be difficult to distinguish in both cytologic and histologic preparations. To determine the cytologic features, we retrospectively analyzed 29 fine needle aspirates with a biopsy-confirmed diagnosis of papilloma or papillary carcinoma. They included 7 intracystic papillary carcinomas, 6 invasive papillary carcinomas and 17 intraductal papillomas. All cases were evaluated for cellularity, single epithelial cells, atypia and papillary fragments. A common pattern was increased cellularity, papillary groups and single columnar epithelial cells. Markedly increased cellularity was present in 10/12 carcinomas and 4/17 papillomas. Numerous single cells were present in 5/12 carcinomas and 2/17 papillomas. The majority of cases had only mild to moderate atypia. Papillary carcinomas displayed nuclear hyperchromasia and stratification surrounding stroma and in isolated clusters. In papillomas, nine cases had background apocrine metaplasia, foam cells and/or bipolar cells. Apocrine metaplasia was absent from all cases of papillary carcinoma. Two papillomas had marked nuclear atypia with background necrosis and inflammation. These unusual cases represented infarcted papillomas, a potential pitfall in the diagnosis of cancer. We conclude that markedly increased cellularity and numerous single cells favor a diagnosis of papillary carcinoma. More specific diagnostic clues are the cytologic findings of nuclear hyperchromasia, stratification and absence of benign background cells, such as apocrine metaplasia.

Adult↗
PubMedDate not supplied

Atypia in fine needle aspiration cytology of nonpalpable and palpable mammographically detected breast lesions.

Widespread use of fine needle aspiration (FNA) in conjunction with mammography may lead to increased atypical or suspicious cytologic diagnoses. To assess the incidence and cytologic criteria of atypia in a mammographically screened population, we reviewed 220 FNA samples in this diagnostic category (5.8% incidence) from 3,798 FNAs performed in 1990-1991. The atypical category (134 cases) included 72 benign and 62 malignant confirmed cases. Common benign diagnoses were fibroadenoma and fibrocystic changes (33 cases, or 46%). Features responsible for an atypical diagnosis in benign cases were increased cellularity, single epithelial cells and "reactive nuclear atypia," the last defined as a finely granular, uniform chromatin pattern with small, prominent nucleoli. The suspicious category included 86 cases; only 10 cases (12%) were confirmed benign lesions, and the remainder were malignant. These benign cases included 3 fibroadenomas, 3 fibrocystic changes, 3 papillomas and 1 scar after radiotherapy. Two cases had prominent inflammation, a finding that should prompt caution. Malignant diagnoses in both categories included infiltrating and in situ cancers. A combination of limited cellularity, drying and/or bland nuclear features precluded a definitive diagnosis of cancer in many cases. For optimal management of mammographically screened patients, an acceptable "atypical" diagnostic rate should be defined for FNA. We conclude that a rate of less than 5% can be achieved by recognition of the following: (1) reactive atypia in the setting of fibrocystic and fibroadenomatous patterns, (2) significance of atypia in the setting of inflammation, and (3) improved sampling and sample preparation.

Adult↗