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DEPARTMENT OF PATHOLOGY, SETH GSMC & KEMH

PROTOCOL FOR DISSERTATION

TITLE-fine needle aspiration cytology of papillary lesion of breast 6 year
retrospective study.

INSTITUTE
DEPARTMENT OF PATHOLOGY, SETH G.S.MEDICAL COLLEGE AND KEM
HOSPITAL, MUMBAI.
INVESTIGATORS
POST-GRADUATE GUIDE (PRINCIPAL INVESTIGATOR)
DR. LEENA NAIK (PROFESSOR)
DEPARTMENT OF PATHOLOGY
SETH G.S. MEDICAL COLLEGE AND KEM HOSPITAL, MUMBAI.
POST-GRADUATE STUDENT (CO-INVESTIGATOR)
DR.GARIMA VIJAYVERGIYA(RESIDENT)
DR.KANCHAN KOTHARI (ASSOCIATE PROFESSOR)
DEPARTMENT OF PATHOLOGY
SETH G.S. MEDICAL COLLEGE AND KEM HOSPITAL, MUMBAI.

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INDEX
TOPIC

PAGE NO.

Introduction

Aims and Objectives

Materials and Methods

2-3

References

ATTACHMENTS
1 .Summary of protocol
2.Case record form

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DEPARTMENT OF PATHOLOGY, SETH GSMC & KEMH

INTRODUCTION :Papillary lesions of the breast are a heterogeneous group of breast

lesions. Cytological interpretation of papillary lesions of breast is a difficult task. These lesions
have risk of false-positive diagnosis .These lesions have varied morphologic features that carry
different prognosis. Accurate diagnosis is required to ensure that effective treatment is achieved.
These lesions present clinically as a mass or nipple discharge without a clinically evident lump.
Papillary lesions of the breast include:1. papillary hyperplasia in fibrocystic disease
2. benign papilloma
3.malignant papillary lesions including

micropapillary, intracystic and invasive papillary

carcinoma.
Papillomas of the breast can be divided into solitary papillomas, multiple papillomas, and
juvenile papillomatosis
Papillary carcinoma is rare, constituting 12% of breast cancer. it can be noninvasive or invasive
papillary carcinoma and invasive micropapillary carcinoma.. The noninvasive form may extend
throughout a ductal system (intraductal) or may be confined within a cystic structure (intracystic).
Rationale-. papillary lesions of breast are wide spectrum of disease. It includes benign as

well as malignant papillary lesions. It is difficult to differentiate between benign and

malignant papillary lesions as it has overlapping cytomorphological features. sometimes
degenerative changes also mimic malignancy . We are carrying out this study, to find out
difficulties faced in diagnosis of papillary lesions of breast, so as to improve dianostic
accuracy.

Parameters that will be used to determine utility of FNAC for diagnosing papillary lesions
of breast:1.background-Blood,calcification,single
macrophages ,myoepithelial cells.

scattered

columnar

cells,

hemosiderin

laden

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2.Cellular features-Cellularity, dissociation,

nuclear atypia, nuclear pseudoinclusions, cell

morphology,e.g.,apocrine,columnar
3.Tissue fragments-Long finger-like branching fragment(complex vs.simple branching,presense
of fibrovascular cores),complex fragments,other than papillary,cellular balls,single detached
papillae,tiny tongue like projections.

AIMS AND OBJECTIVES

This will be a 6 year retrospective study dealing with:
1) Utility of Fine Needle Aspiration Cytology (FNAC) in diagnosis of papillary lesions of
breast
2) To determine the cytomorphological spectrum of the papillary lesion of breast FNAC
3) To correlate Fine Needle Aspiration Cytology finding of cases diagnosed as papillary
lesion of breast with histopathology
4) To determine diagnostic accuracy of the FNAC in the diagnosis of papillary lesion
5) To find incidence of false positive and false negative cases

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MATERIALS AND METHODS

This will be a 6 year retrospective study

Inclusion criteria-all the case which have been diagnosed as papillary lesion on FNAC
and also all the lesions which are diagnosed as papillary lesions of breast on
histopathology, which have not been diagnosed as papillary lesion on FNAC.So false
negative test would not be missed.

Exclusion criteria-Lesions diagnosed as non papillary lesions on both FNAC and

histopathology.

Clinical history & notes of 75 patients will be obtained from the databases of cytology
section in Department of Pathology, Medical record department and surgical
histopathology section.

The FNAC slides obtained by aspiration and non aspiration technique, stained with
Giemsa and PAP stain will be retrieved and studied.

The cases will be analysed based on the cytological features and correlated with
histopathological records.

Sensitivity, specificity, positive and negative predictive value will be calculated.

Statistical analysis will be performed by using software programme available for the
same known as SPSS (Statistical Package for Social Sciences).

FORMULAS-

Sensitivity-True positive/true positive+false negative

Specificity-Truel negative/false positive+true negative

Positive predictive value-True positive/true positive+false positive

Negative predictive value-True negative /true negative+false negative

Where the False negative cases - which are diagnosed non papillary on FNAC and
diagnosed as papillary on histopath.

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False positive cases - which are diagnosed as papillary on FNAC and non papillary on
histopathology.
False negative test for malignancy- when in FNAC lesion diagnosed as benign and on
histopathology diagnosed as malignant.
False positive test for malignancy-when in FNAC lesion diagnosed as malignant and on
histopathology diagnosed as benign.

OBSERVATION:
Cytological findings will be correlated with Histopathological
records. Incidence of various lesions will be studied.
All the cases
1.

cases diagnosed as papillary lesions on FNAC will be on histopathology follow up.

2.

Cases diagnosed as nonpapillary on FNAC but diagnosed as papillary on histopath

examination.

3.

All the cases which were diagnosed as papillary lesion on FNAC, but revealed as
non-papillary on further histopathological examinations will be studied in detail.

Slides will be retrived and various variant of papillary lesion will be studied.
Sensitivity, specificity, positive and negative predictive value will be calculated.
Statistical analysis will be performed by using software programme available for the
same known as SPSS (Statistical Package for Social Sciences).

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REFERENCES
1.D Prathiba, Shalinee Rao, [...], and Leena Dennis Joseph Papillary lesions of breast An
introspect of cytomorphological features Jcytol jan 2010,27(1) :12-15
2.Nayar R, De Frias DV, Bourtsos EP, Sutton V, Bedrossian C. Cytological differential diagnosis of
papillary pattern in breast aspirates: Correlation with histology. Ann Diagn Pathol. 2001;5:34
42. [PubMed]
3.Tse GM, Ma TK, Lui PC, Ng DC, Yu AM, Vong JS, et al. Fine needle aspiration cytology of
papillary lesions of the breast: How accurate is the diagnosis? J Clin Pathol. 2008;61:9459.
[PubMed
4.Reid-Nicholson MD, Tong G, Cangiarella JF, Moreira AL. Cytomorphologic features of papillary
lesions of the male breast: a study of 11 cases. Cancer. 2006;108:222230
5.Jeffrey PB, Ljung BM. Benign and malignant papillary lesions of the breast. A
cytomorphological study.Am J ClinPathol.1994;101:500-507
6.Michael CW, Buschmann B. Can true papillary neoplasms of
breast and their mimickers be accurately classified by cytology?Cancer (Cancer Cytopathol).2002;96:92100

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SUMMARY
Papillary lesion of breast encompass wide spectrum of lesions both benign and malignant. It
constitutes 1-2% of cases. These lesions have varied clinical, radiological features which causes
diagnostic difficulties.
This retrospective study of 6 years, will highlight the spectrum of cytomorphological findings of
papillary lesion of breast.
Clinical, and histopathological correlation will help to assess sensitivity, specificity, accuracy,
positive and negative predictive value of FNAC in diagnosing papillary lesion of breast.

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CASE RECORD FORM

Date
Pathology number:Age: -

Registration number :Sex:-

Clinical Presentation:Investigations:(I) SONOGRAPHY

(II) MAMMOGRAPHY
(III)

Other relevant investigations

Description of lesion:Gross findings:Microscopic findings:1.Cytological ii) Histopathological

Final Impression:Principal investigator:-

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CASE RECORD FILE

Sr. No.

1.

2.

3.

4.

5.

Patholog
y No.

Age

Sex

Registrat Descript
ion No.
ion of
the
lesion

Cytologi
cal
diagnosi
s

Histopat
hologica
l finding

Sonogra
phic
finding

Mammo
graphic
finding

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