Diagnostic evaluation of necrotic debris in breast aspiration cytology: A diagnostic flow-chart by the new reporting form of breast cytology

Objective: To develop a diagnostic evaluation method based on the presence of necrotic debris in breast aspirates. Study Design: A total of 906 cytological materials obtained by breast FNA were investigated. The present study included 524 malignant and 382 benign lesions. Results: Necrotic debris was observed in 173 of the breast lesions. Of these lesions, 151 (87.3%) were malignant and 22 (12.7%) were benign. Comedo-type carcinoma in non-invasive ductal carcinoma and papillotubular carcinoma had the highest incidences. Massive calcification with necrotic debris strongly indicates a comedo type carcinoma of the breast. Cytology obtained from infarcted breast lesions revealed scattered necrosis with extensive degenerated columnar, polygonal and spindle cells, occasional hyperchromatic epithelial cells and ghost cells. Viable epithelial and stromal cells provided valuable diagnostic information. Materials mimicking necrotic debris were also investigated. Conclusions: Cytologic features and the diagnostic evaluation of necrotic debris in breast FNA specimens are usefull for the differential diagnosis of breast lesions.