Skip to main content
SpringerLink
Log in

Benign

  • Chapter
  • First Online:
The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology

  • 1289 Accesses

Abstract

This chapter defines a benign FNAB and describes and illustrates the cytological features characteristic of specific benign neoplastic and non-neoplastic breast lesions. For each specific entity the clinical and imaging findings are described, and the key cytological diagnostic criteria are listed. The differential diagnosis and potential pitfalls in interpretation and diagnosis are discussed with emphasis on avoiding a false-positive diagnosis. This is particularly relevant in the diagnosis of fibroadenoma and intraductal papillomas. The category also includes a number of lesions that do not require an epithelial component for definitive diagnosis if the features are concordant with the clinical and radiological findings, including breast abscess, cysts, fat necrosis and granulomatous inflammation. Guidelines for optimal management are provided, tailored to different clinical settings with different resource facilities. Finally, a range of sample reports are provided to facilitate optimal communication with the clinical team.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 89.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. O’Neill S, Castelli M, Gattuso P, Kluskens L, Madsen K, Aranha G. FNA of nonpalpable breast lesions; a review of 1885 FNA cases using the NCI-supported recommendations on the uniform approach to breast FNA. Cancer. 1999;87:19–24.

    Article  Google Scholar 

  2. Boerner S, Fornage BD, Singletary E, Sneige N. Ultrasound-guided fine-needle aspiration (FNA) of nonpalpable breast lesions: a review of 1885 FNA cases using the National Cancer Institute-supported recommendations on the uniform approach to breast FNA. Cancer. 1999;87(1):19–24.

    Article  CAS  Google Scholar 

  3. Day C, Moatamed N, Fimbres AM, Salami N, Lim S, Apple SK. A retrospective study of the diagnostic accuracy of fine-needle aspiration for breast lesions and implications for future use. Diagn Cytopathol. 2008;36(12):855–60.

    Article  Google Scholar 

  4. Wang M, He X, Chang Y, Sun G, Thabane L. A sensitivity and specificity comparison of fine needle aspiration cytology and core needle biopsy in evaluation of suspicious breast lesions: A systematic review and meta-analysis. Breast. 2017;31:157–66.

    Article  Google Scholar 

  5. Hoda R, Brachtel E. IAC Yokohama system for reporting breast FNAB cytology: a review of predictive values and risks of malignancy. Acta Cytol. 2019; 63:292–301.

    Google Scholar 

  6. Wong S, Rickard M, Earls P, Arnold L, Bako B, Field AS. The IAC Yokohama System for Reporting Breast FNAB Cytology: a single institutional retrospective study of the application of the System and the impact of ROSE. Acta Cytol. 2019;63:280–91.

    Google Scholar 

  7. Montezuma D, Malheiros D, Schmitt F. Breast FNAB cytology using the newly proposed IAC Yokohama System for Reporting Breast Cytopathology: the experience of a single institution. Acta Cytol. 2019;63:274–9.

    Google Scholar 

  8. Singh N, Wells CA. Invited review: assessment of accuracy in breast cytology. Cytopathology. 2001;12:211–8.

    Article  CAS  Google Scholar 

  9. Castells X, Domingo L, Corominas JM, et al. Breast cancer risk after diagnosis by screening mammography of nonproliferative or proliferative benign breast disease: a study from a population-based screening program. Breast Cancer Res Treat. 2015;149(1):237–44.

    Article  Google Scholar 

  10. Hartmann LC, Sellers TA, Frost MH, et al. Benign breast disease and the risk of breast cancer. N Engl J Med. 2005;353(3):229–37.

    Article  CAS  Google Scholar 

  11. Field AS. Chapter 5 Breast. In: Field AS, Zarka MR, editors. Practical Cytopathology: Pattern Recognition Diagnostic Approach. Saint Louis: Elsevier; 2016.

    Google Scholar 

  12. Ducatman BS, Wang HH. Breast. In: Cibas E, Ducataman B, editors. Ch 9 in Cytology: Principles and Clinical Correlates. 4th ed. Philadelphia: Elsevier/Saunders; 2014.

    Google Scholar 

  13. Trott PA. Aspiration cytodiagnosis of the breast. Diagn Oncol. 1991;1:79–87.

    Google Scholar 

  14. Mendoza P, Lacambra M, Tan PH, Tse GM. Fine needle aspiration cytology of the breast: the nonmalignant categories. Pathol Res Int. 2011;2011:547580.

    Article  Google Scholar 

  15. Abdalla F, Boder J, Markus R, Hashmi H, Buhmeida A, Collan Y. Correlation of nuclear morphometry of breast cancer in histological sections with clinicopathological features and prognosis. Anticancer Res. 2009;29:1771–6.

    PubMed  Google Scholar 

  16. Kashyap A, Jain M, Shukla S, Andley M. Study of nuclear morphometry on cytology specimens of benign and malignant breast lesions: a study of 122 cases. J Cytol. 2017;34(1):10–5.

    Article  Google Scholar 

  17. Kakkar S, Kapita K, Singh MK, Verma K. Tuberculosis of the breast. A cytomorphological study. Acta Cytol. 2000;44:292–6.

    Article  CAS  Google Scholar 

  18. Tandom M, Chintamami, Panwar P. Breast tuberculosis at a teaching care centre: a retrospective analysis of 22 cases. Breast Dis. 2014;34:127–30.

    Article  Google Scholar 

  19. Dodd LG, Sneige N, Reece GP, Fornage B. FNAC of silicone granulomas in the augmented breast. Diagn Cytopathol. 1993;31:241–4.

    Google Scholar 

  20. Santos-Briz A Jr, Lopez-Rios F, Santos-Briz A, De Agustin PP. Granulomatous reaction to silicone in axillary lymph nodes; a case report with cytologic findings. Acta Cytol. 1999;43:1163–5.

    Article  Google Scholar 

  21. Dorfield JM, Thompson SK, Shurbaji MS. Radiation induced changes in the breast: a potential diagnostic pitfall on FNA. Diagn Cytopathol. 1992;8:78–80.

    Google Scholar 

  22. Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vivjer M. In: Bosman FTJE, Lakhani SR, Ohgaki H, editors. WHO classification of tumours of the breast. 4th ed. International Agency for Research of Cancer: Lyon; 2012.

    Google Scholar 

  23. Orell S. Radial scar/complex sclerosing lesion—a problem in the diagnostic work-up of screen detected breast lesions. Cytopathology. 1999;10:250–8.

    Article  CAS  Google Scholar 

  24. Schnitt SJ, Collins LC. Columnar cell lesions and flat epithelial atypia of the breast. Semin Breast Dis. 2005;8:100–11.

    Article  Google Scholar 

  25. Silverman JF, Massod S, Ducatman BS, et al. Can FNA biopsy separate atypical hyperplasia, carcinoma in-situ, and invasive carcinoma of the breast? Cytomorphologic criteria and limitations in diagnosis. Diagn Cytopathol. 1993;24:630–5.

    Google Scholar 

  26. Simsir A, Waisman J, Cangiarella J. Fibroadenomas with atypia: causes of under and overdiagnois by aspiration biopsy. Diagn Cytopathol. 2001;25:278–84.

    Article  CAS  Google Scholar 

  27. Stanley MW, Tani EM, Skoog L. Fine needle aspiration of fibroadenomas of breast with atypia: a spectrum including cases that cytologically mimic carcinoma. Diagn Cytopathol. 1990;6:375–82.

    Article  CAS  Google Scholar 

  28. Kollur SM, El Haag IA. FNA of breast fibroadenoma: observer variability and review of cytomorphology with cytohistological correlation. Cytopathology. 2006;17:239–44.

    Article  CAS  Google Scholar 

  29. Shabb NS, Boulos FI, Abdul-Karim FW. Indeterminate and erroneous fine-needle aspirates of breast with focus on the “true gray zone”: a review. Acta Cytol. 2013;57:316–31.

    Article  Google Scholar 

  30. Ohashi R, Matsubara M, Watarai Y, Yanagihara K, Yamashita K, Tsuchiya S, Takei H, Naito Z. Cytological features of complex type fibroadenoma in comparison with non-complex type fibroadenoma. Breast Cancer. 2016;23:724–31.

    Article  Google Scholar 

  31. Stafyla V, Kotsifopoulos N, Grigoriades K, Kassaras G, Sakorafas GH. Lobular carcinoma in situ of the breast within a fibroadenoma. A case report. Gynecol Oncol. 2004;94:572–4.

    Article  Google Scholar 

  32. Shield PW, Ribu DL, Cominos D. The significance of extracellular mucin in breast fine-needle aspiration specimens. Cytopathology. 2016;27:185–92.

    Article  CAS  Google Scholar 

  33. Field A, Mak A. The fine needle aspiration biopsy diagnostic criteria of proliferative breast lesions: a retrospective statistical analysis of criteria for papillomas and radial scar lesions. Diagn Cytopathol. 2007;35(7):386–97.

    Article  Google Scholar 

  34. Simsir A, Cangiarella J. Challenging breast lesions: pitfalls and limitations of FNA and the role of core biopsy in specific lesions. Diagn Cytopathol. 2012;40:262–72.

    Article  Google Scholar 

  35. Bhattari S, Kapila K, Verma K. Phyllodes tumour of the breast. A cytopathologic study of 820 cases. Acta Cytol. 2000;44:790–6.

    Article  Google Scholar 

  36. Scolyer RA, McKenzie PR, Achmed D, Lee CS. Can phyllodes tumours of the breast be distinguished from fibradenomas using fine needle aspiration cytology? Pathology. 2001;33:437–43.

    Article  CAS  Google Scholar 

  37. Jayaram G, Sthaneshwar P. Fine needle aspiration cytology of phyllodes tumours. Diagn Cytopathol. 2002;26:222.

    Article  Google Scholar 

  38. Tse GM, Ma TK, Pang LM, Cheung H. Fine needle aspiration cytologic features of mammary phyllodes tumors. Acta Cytol. 2002;46(5):855–63.

    Article  Google Scholar 

  39. Krishnamurthy S, Ashfaq R, Shin HJ, Sneige N. Distinction of phyllodes tumour from fibroadenoma: a reappraisal of an old problem. Cancer. 2000;90:342–9.

    Article  CAS  Google Scholar 

  40. Maritz RM, Michelow PM. Cytological criteria to distinguish phyllodes tumour of the breast from fibroadenoma. Acta Cytol. 2017;6(6):418–24.

    Article  Google Scholar 

  41. Mulvany N, Lowhagen T, Skoog L. Fine needle aspiration cytology of tubular adenoma of the breast. A report of two cases. Acta Cytol. 1994;38:961–4.

    CAS  PubMed  Google Scholar 

  42. Field AS, Mak A. A prospective study of the diagnostic accuracy of cytological criteria in the FNAB diagnosis of breast papillomas. Diagn Cytopathol. 2007;35:465–75.

    Article  Google Scholar 

  43. Greenberg ML, Middleton PD, Bilous M. Infarcted intraduct papilloma diagnosed by fine needle biopsy. A cytologic, clinical and mammographic pitfall. Diagn Cytopathol. 1994;11:188–94.

    Article  CAS  Google Scholar 

  44. Ozaki S, Mizukami Y, Kawahara E. Cytologic features of nipple adenoma: a report of four cases of adenoma of the nipple. Diagn Cytopathol. 2015;43:664–8.

    Article  Google Scholar 

  45. Collins LC, Schnitt SJ. Papillary lesions of the breast: selected diagnostic and management issues. Histopathology. 2008;52:20–9.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of NSW and University of Notre Dame Medical Schools, St Vincent’s Hospital, Sydney, Australia

    Andrew S. Field

  2. Department of Pathology, University of Trieste, Trieste, Italy

    Luigi Di Bonito

  3. Department of Pathology, University Hospital of Trieste, Trieste, Italy

    Maurizio Pinamonti

  4. Cytology Unit, Department of Anatomical Pathology, Faculty of Health Science, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, Gauteng, South Africa

    Pamela Michelow

  5. Flinders Medical Centre, Flinders University of South Australia and Clinpath Laboratories, Adelaide, Australia

    Wendy A. Raymond

  6. Akershus University Hospital, Department of Pathology, Lørenskog, Viken, Norway

    Torill Sauer

  7. Department of Histopathology, Nottingham University Hospitals, Nottingham, UK

    Andrew H. S. Lee

  8. St. George Hospital, BreastScreen, Sydney, NSW, Australia

    Mary T. Rickard

  9. Sydney Breast Clinic, Sydney, NSW, Australia

    Lauren Arnold

  10. Toronto, ON, Canada

    William R. Geddie

  11. Institute of Molecular Pathology and Immunology of Porto University (IPATIMUP), Medical Faculty of Porto University, Porto, Portugal

    Fernando Schmitt

Authors
  1. Andrew S. Field
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luigi Di Bonito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maurizio Pinamonti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pamela Michelow
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wendy A. Raymond
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Torill Sauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrew H. S. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mary T. Rickard
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lauren Arnold
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. William R. Geddie
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Fernando Schmitt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew S. Field .

Editor information

Editors and Affiliations

  1. University of NSW and University of Notre Dame Medical Schools, St Vincent’s Hospital, Sydney, Australia

    Andrew S. Field

  2. Flinders Medical Centre, Flinders University of South Australia and Clinpath Laboratories, Adelaide, Australia

    Wendy A. Raymond

  3. Institute of Molecular Pathology and Immunology of Porto University (IPATIMUP), Medical Faculty of Porto University, Porto, Portugal

    Fernando Schmitt

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Field, A.S. et al. (2020). Benign. In: Field, A.S., Raymond, W.A., Schmitt, F. (eds) The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology. Springer, Cham. https://doi.org/10.1007/978-3-030-26883-1_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-26883-1_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26882-4

  • Online ISBN: 978-3-030-26883-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation