Objectives: To identify features that could define papillary ductal cell proliferation within the C3 category and to subcategorise papillary lesions into benign papillomas which can be managed conservatively and atypical/malignant papillary neoplasms which require surgical intervention. Study Design: A blind microscopic rescreen of all C3 cases was conducted. The corresponding histological outcome was compared with the cytology. Statistical analysis was performed using papillary versus non-papillary outcomes and benign versus atypical/malignant papillary lesions. In addition, macropapillary lesions (papilloma and encysted papillary carcinoma) were plotted against micropapillary ductal carcinoma in situ. Results: Two hundred thirty FNA cases reported as C3 included 72 papillary neoplasms (52 benign papillomas and 20 atypical/malignant papillary lesions). Features specific to papillary lesions within C3 include macropapillary fragments, complex sheets, palisading strips, cystic background, cohesion and a decreased nuclear-to-cytoplasmic ratio. Features favouring atypical/malignant papillary lesions include decreased numbers of bare bipolar nuclei, discohesion and a non-cystic background. These features are common to most breast malignancies; however, identification of papillary features often results in a downgraded diagnosis from C5. Conclusions: This study supports the ability to reliably identify papillary ductal cell proliferation within C3. Certain features can distinguish papillary lesions from other C3 pathologies. This separation is likely to be clinically useful as papillary lesions may require a different management approach.

Keywords:
Papillary lesion, Breast, FNA, C3 category, Receiver operating characteristic curve
1.
Zanconati F, Romano A, Martellani F, Ober E, Giudici F, Pinamonti M, Bonifacio D, Bottin C, Tonutti M, Bortul M, et al: Breast FNAC in mammografic screening program of Trieste, Italy: S13-S74. Cytopathology 2012;23(suppl):31-32.
2.
Smith MJ, Heffron CC, Rothwell JR, Loftus BM, Jeffers M, Geraghty JG: Fine needle aspiration cytology in symptomatic breast lesions: still an important diagnostic modality? Breast J 2012;18:103-110.
3.
The uniform approach to breast fine-needle aspiration biopsy. National Cancer Institute Fine-Needle Aspiration of Breast Workshop Subcommittees. Diagn Cytopathol 1997;16:295-311.
4.
National Breast Cancer Centre: Breast Fine Needle Aspiration Cytology and Core Biopsy: A Guide for Practice, ed 1. Camperdown, National Breast Cancer Centre, 2004.
5.
Bulgaresi P, Cariaggi P, Ciatto S, Houssami N: Positive predictive value of breast fine needle aspiration cytology (FNAC) in combination with clinical and imaging findings: a series of 2,334 subjects with abnormal cytology. Breast Cancer Res Treat 2006;97:319-321.
6.
Weigner J, Zardawi I, Braye S: The true nature of atypical breast cytology. Acta Cytol 2013;57:464-472.
7.
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;57:316-331.
8.
Ueng SH, Mezzetti T, Tavassoli FA: Papillary neoplasms of the breast: a review. Arch Pathol Lab Med 2009;133:893-907.
9.
Masood S, Rosa M: Borderline breast lesions: diagnostic challenges and clinical implications. Adv Anat Pathol 2011;18:190-198.
10.
Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijver MJ: WHO Classification of Tumours of the Breast. Lyon, World Health Organisation, 2012, vol 4.
11.
Ibarra JA: Papillary lesions of the breast. Breast J 2006;12:237-251.
12.
Papeix G, Zardawi I, Douglas CD, Clark DA, Braye SG: The accuracy of the ‘triple test' in the diagnosis of papillary lesions of the breast. Acta Cytol 2012;56:41-46.
13.
Collins LC, Schnitt SJ: Papillary lesions of the breast: selected diagnostic and management issues. Histopathology 2008;52:20-29.
14.
StataCorp: Stata Release II. College Station, StataCorp, 2009.
15.
Fan J, Upadhye S, Worster A: Understanding receiver operating characteristic (ROC) curves. CJEM 2006;8:19-20.
16.
Weigner J, Zardawi I, Braye S, McElduff P: The microscopic complexities of C3 in breast cytology. Acta Cytol 2014;58:335-346.
17.
Yamaguchi R, Tanaka M, Tse GM, Yamaguchi M, Terasaki H, Hirai Y, Nonaka Y, Morita M, Yokoyama T, Kanomata N, et al: Management of breast papillary lesions diagnosed in ultrasound-guided vacuum-assisted and core needle biopsies. Histopathology 2015;66:565-576.
18.
Field A, Mak A: A prospective study of the diagnostic accuracy of cytological criteria in the FNAB diagnosis of breast papillomas. Diagn Cytopathol 2007;35:465-475.
19.
Tse GMK, Ma TKF, Lui PCW, Ng DCH, Yu AMC, Vong JSL, Niu Y, Chaiwun B, Lam WWM, Tan PH: Fine needle aspiration cytology of papillary lesions of the breast: how accurate is the diagnosis? J Clin Pathol 2008;61:945-949.
20.
Sneige N: Fine-needle aspiration cytology of in situ epithelial cell proliferation in the breast. Am J Clin Pathol 2001;113(suppl 1):S38-S48.
21.
Nayar R, De Frias DV, Bourtsos EP, Sutton V, Bedrossian C: Cytologic differential diagnosis of papillary pattern in breast aspirates: correlation with histology. Ann Diagn Pathol 2001;5:34-42.
22.
Jayaram G, Elsayed EM, Yaccob RB: Papillary breast lesions diagnosed on cytology: profile of 65 cases. Acta Cytol 2007;51:3-8.
23.
Simsir A, Waisman J, Thorner K, Cangiarella J: Mammary lesions diagnosed as ‘papillary' by aspiration biopsy. Cancer 2003;99:156-165.
24.
Bibbo M: Comprehensive Cytopathology. Chicago, Saunders, 1991.
25.
DeMay R: The Art and Science of Cytopathology, ed 2. Chicago, ASCP Press, 2012, vol 2.
26.
Choi YD, Gong GY, Kim MJ, Lee JS, Nam JH, Juhng SW, Choi C: Clinical and cytologic features of papillary neoplasms of the breast. Acta Cytol 2006;50:35-40.
27.
Michael CW, Buschmann B: Can true papillary neoplasms of breast and their mimickers be accurately classified by cytology? Cancer 2002;96:92-100.
28.
Jaffer S, Reid-Nicholson M, Bleiweiss IJ: Infiltrating micropapillary carcinoma of the breast: cytologic findings. Acta Cytol 2002;46:1081-1087.
29.
Jimenez-Ayala M: Micropapillary carcinoma and mucinous carcinoma with a micropapillary pattern. Acta Cytol 2007;51:1-2.
30.
Kelten EC, Akbulut M, Duzcan SE: Diagnostic dilemma in cytologic features of micropapillary carcinoma of the breast: a report of 2 cases. Acta Cytol 2009;53:463-466.
31.
Pettinato G, Pambuccian SE, Di Prisco B, Manivel JC: Fine needle aspiration cytology of invasive micropapillary (pseudopapillary) carcinoma of the breast: report of 11 cases with clinicopathologic findings. Acta Cytol 2002;46:1088-1094.
32.
Masood S, Loya A, Khalbuss W: Is core needle biopsy superior to fine-needle aspiration biopsy in the diagnosis of papillary breast lesions? Diagn Cytopathol 2003;28:329-334.
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2015
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