Fine needle aspiration biopsy of breast carcinoma in pregnancy and lactation

OBJECTIVE: To delineate the cytomorphologic features seen in cancer of the breast during pregnancy and lactation, to compare them to the cytomorphologic parameters in benign conditions and to determine the feasibility of differentiating features of malignant breast carcinoma from those of benign breast lesions during pregnancy. STUDY DESIGN: The study group consisted of pregnant or lactating women with breast carcinoma and with benign breast lesions who underwent fine needle aspiration (FNA) of the breast lesions. The findings of FNA were reviewed, analyzed, tabulated and correlated with the pathologic diagnosis of the breast biopsies. RESULTS: Eleven patients had malignant cytomorphologic changes, including increased cellularity, multilayering, enlarged and pleomorphic nuclei, single or multiple nucleoli, mitosis and numerous isolated tumor cells. Secretory changes were scanty. The background was foamy and necrotic. FNA of the benign lesions showed a biphasic cell pattern with cohesion; minimal nuclear pleomorphism; single, regular nucleoli; and naked nuclei in a granular background with foamy macrophages. Increased cellularity with nuclear atypia, single cells and a dirty background was seen in benign and malignant conditions. CONCLUSION: The main cytologic features that differentiate breast carcinoma from benign conditions during pregnancy and lactation are crowding and overlapping of nuclei, dyscohesion and enlarged, pleomorphic nuclei with irregular nuclear membranes, coarse nuclear chromatin and mitoses. Pregnancy-related hyperplastic changes with atypia can potentially result in a false positive diagnosis of carcinoma.     

Fine needle aspiration biopsy of the salivary glands. A five-year experience with emphasis on diagnostic pitfalls

OBJECTIVE: To review the fine needle aspiration (FNA) findings in 151 patients who presented with salivary gland (both major and minor) enlargement from January 1991 to December 1995 in order to determine its sensitivity and specificity and to study the various pitfalls. STUDY DESIGN: The study group consisted of 77 males and 74 females, 16-98 years old (average 55). One hundred twenty-five aspirates (83%) were from the parotid gland, 23 (15%) from the submandibular gland and 3 (2%) from the soft palate. One hundred thirty-seven cases (91%) were adequate for diagnosis. There were 89 (59%) aspirations done by cytopathologists, 100% of which were diagnostic, and 62 (41%) done by clinicians, 48 (77%) of which were diagnostic. Sixty-eight (45%) cases had histologic confirmation. There were 104 (75.9%) benign, 20 (14.6%) malignant and 13 (9.5%) atypical cytologic diagnoses. RESULTS: Using histology as the "gold standard," the sensitivity of FNA cytology was 91%, with a specificity of 96%. A number of problems were encountered in interpreting some cases, not only in differentiating benign from malignant ones but also in the specific classification of these neoplasms. Problems encountered involved differentiating hematopoietic from non-hematopoietic lesions and interpretation of spindle cell neoplasms, acinic cell carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, lymphoproliferative disorders, postirradiation changes, sialadenitis and atypia in pleomorphic adenoma. CONCLUSION: FNA biopsy of the salivary gland is a sensitive and specific diagnostic tool at our institution. Particular attention to subtle morphologic changes may aid in avoiding pitfalls and arriving at the right diagnosis.     

Fine needle aspiration diagnosis of pilomatrixoma. A case report

BACKGROUND: Fine needle aspiration (FNA) diagnosis of pilomatrixoma is rare. The cytologic presentation can be mistaken for squamous cell carcinoma because of high cellularity, high nuclear/cytoplasmic ratio and presence of anucleate squames. CASE: A 25-year-old male presented to Cook County Hospital with a slowly enlarging neck mass of three months' duration. FNA was interpreted as consisted with pilomatrixoma. Subsequently the patient had the mass removed. Histology confirmed the diagnosis of pilomatrixoma. CONCLUSION: The wide range of cell differentiation in conjunction with pertinent clinical findings, absence of nuclear atypia, tumor diathesis, mitotic figures and awareness of the entity lead to the correct diagnosis of pilomatrixoma.     

Intestinal parasites in the vendors and consumers of street food. A study conducted in the Dakar area

To determine the origin and nature of mucinlike material in fine-needle aspiration (FNA) smears of the breast in noncancerous breast lesions, we studied breast FNA smears from four patients. All smears contained epithelial cells floating in a mucinlike background, which raised suspicion for mucinous (colloid) carcinoma. Mucicarmine stain was performed on one smear from each case. Subsequent tissue biopsy specimens were studied using mucicarmine, periodic acid-Schiff with and without diastase, and alcian blue stains at pH 2.7 and 0.9 on selected tissue sections. Correlation of the cytologic and histologic findings of each lesion was performed. The mucinlike background in all four FNA smears stained strongly with mucicarmine. Corresponding biopsy specimens revealed pseudoangiomatous hyperplasia in the first case, fibroadenoma and atypical ductal hyperplasia in the second, benign phyllodes tumor in the third, and fibroadenoma in the fourth. Each lesion in cases 1 to 3 was associated closely with fibrocystic changes. In case 4, cystic changes were located within the fibroadenoma. On tissue sections of all four cases, the cyst contents and 10% to 50% of normal lobule and duct contents stained with mucicarmine, indicating that the cyst contents were the most probable source of mucin in the FNA smears. The presence of pools of mucicarmine-positive material in FNA smears of the breast is not an exclusive feature of mucinous carcinoma; mucicarmine-positive mucin can arise from benign cystic changes as well as from normal lobules and ducts.     

Randomized trial of physical exercise alone or combined with bright light on mood and health-related quality of life

OBJECTIVE: To present our experience with liver fine needle aspiration (FNA) diagnosis based on Riu's stain. STUDY DESIGN: We reviewed a total of 322 liver fine needle aspirates from 286 patients seen in a seven-year period from April 1990 to April 1997 at Koo Foundation Sun Yat-Sen Cancer Center, Taipei. Surgical and/or clinical follow-up was available for confirmation in 292 aspirates. RESULTS: The cytologic diagnosis was categorized into four groups: benign in 81 cases, suspicious in 13, malignant in 225, and inadequate specimen in 3 cases. There were 16 false negative and no false positive diagnoses. Two suspicious aspirates were negative. Our results showed a sensitivity of 93.3% and a specificity of 100% for the detection of malignancy. If suspicious cases were considered positive, the specificity decreased to 95.1%, while the sensitivity increased to 93.6%. Among 87 hepatocellular carcinomas (HCCs) in our series, correct FNA diagnosis was made in 84 cases with an accuracy of 96.6%. Out of 135 cases of non-HCCs, 1 was incorrectly diagnosed. The accuracy of identifying a liver malignancy as non-HCC was 99.3%. CONCLUSION: Cytologic features of HCC are well demonstrated by Riu's stain, with high accuracy in identifying them. Liver FNAs using Riu's stain combined with cell block study and clinicopathologic correlation can achieve very high sensitivity and specificity in the detection of hepatic malignancies.     

Stereotactic fine needle aspiration in the management of mammographic abnormalities detected in breast screening

BACKGROUND: Fine needle aspiration (FNA) is used routinely in the management of palpable breast lumps; with the implementation of the stereotactic technique its use has been extended to the investigation of mammographic abnormalities. The advent of breast screening means that many mammographic abnormalities will be detected; because routine open biopsy is impractical and undesirable, stereotactic fine needle aspiration becomes the method of choice for investigation. METHOD: Within a 28 month interval, 81 Chinese women underwent stereotactic FNA in Kwong Wah Hospital, Hong Kong. RESULTS: Fifty-one women (62.9%) had a benign cytology result and no further investigations were required. Inconclusive results were obtained in 18.6% of the aspirates. Open biopsy was required in 16 women (19.8%). CONCLUSION: Stereotactic FNA is very useful in the exclusion of malignancy and the avoidance of open biopsy in asymptomatic women who have mammographic abnormalities.     

Fine-needle aspiration of histiocytic necrotizing lymphadenitis (Kikuchi's disease)

Fine-needle aspiration (FNA) of the lymph node was done in five patients with histiocytic necrotizing lymphadenitis (Kikuchi's disease). In four patients, the aspirates were found to have many small and large atypical lymphocytes, some reactive, phagocytic histiocytes, and intense extracellular debris. Neutrophils, plasma cells, or multinucleated giant cells were not seen. These cytologic findings were considered diagnostic for Kikuchi's disease. In one patient, the aspirate did not show significant histiocytosis or tissue necrosis and was considered nondiagnostic. In patients with both typical clinical features and characteristic cytologic findings in the lymph node aspirates, FNA of the lymph node alone will suffice for diagnosis. In those patients with typical clinical features but nondiagnostic findings in the FNA aspirates, the diagnosis of Kikuchi's disease may have to be established either on repeated nodal FNA or on lymph node biopsy.     

Specimen adequacy and false-negative diagnosis rate in fine-needle aspirates of palpable breast masses

BACKGROUND: As fine-needle aspiration (FNA) has become a critical component of the investigation of palpable breast masses, false-negative diagnoses have become a major concern, prompting reevaluation of the definition of specimen adequacy. Although cytopathologists agree that a number of parameters relate to the adequacy of an FNA specimen, there is no unanimity on the role of epithelial cell quantitation in the determination of an adequate FNA. To better understand the significance of epithelial cellularity, false-negative FNA samples from palpable breast lesions were reviewed. METHODS: False-negative FNA smears of palpable breast masses that had been performed and assessed immediately by cytopathologists were retrieved from the files of The University of Texas M. D. Anderson Cancer Center, and the number of epithelial cell clusters (ECCs) was determined. Aspirates were classified as adequate if a total of six or more ECCs (each comprised of at least five to ten well preserved cells) were present on all slides, or as inadequate if fewer than six ECCs were present. RESULTS: From 4455 aspirates of palpable breast masses, 51 false-negative aspirates were identified, 41 of which were available for review. No interpretative errors were identified. Twenty-one FNAs (51.2%) were classified as adequate and 20 FNAs (48.8%) as inadequate. The adequate false-negative aspirates contained between 8 to 100 ECCs. A comparison of adequate and inadequate false-negative specimens showed no significant differences in the mean age of patients (56.4 years vs. 57.8 years), the mean number of FNA passes (3.7 passes vs. 3.0 passes), the mean palpation size of the lesions (2.8 cm vs. 2.9 cm), or the mean pathologic size of the lesions (2.1 cm vs. 2.2 cm). Cases of invasive lobular carcinoma were more common in the false-negative smears with fewer than six ECCs. CONCLUSIONS: Including the number of ECCs as a parameter of adequacy could reduce the rate of false-negative FNA diagnoses of palpable breast masses by approximately 50%. However, the presence or even abundance of ECCs does not eliminate the potential for a false-negative cytologic diagnosis. Cytologic diagnoses must be correlated with clinical and imaging findings (the triple test) to reduce the rate of false-negative cases, but benign triple test results do not entirely exclude the possibility of carcinoma, and such cases require periodic follow-up.     

Cytologic diagnosis of signet-ring cell carcinoma of the breast

OBJECTIVE: To examine the cytologic features of signet-ring cell carcinoma (SRCC), defined as carcinoma dominated by signet-ring cells, of the breast and to discuss problems that occur in cytodiagnosis. STUDY DESIGN: Five cases of SRCC of the breast were examined cytopathologically. Signet-ring cells were subclassified into intracytoplasmic lumina (ICL) type and non-ICL type. ICL type had large ICL containing mucin. Non-ICL-type cells had wide, amorphous cytoplasm diffusely dispersed with mucin. RESULTS: In cases 1 and 2, fine needle aspiration biopsy (FNAB) revealed many signet-ring cells (non-ICL type), suggesting SRCC. Histologic diagnoses were ductal SRCC containing many signet-ring cells (non-ICL type). In cases 3 and 4, signet-ring cells (ICL type) were found sporadically among carcinoma cells without signet-ring features. Signet-ring cells were not regarded as the major component of the cells; thus, the cytologic diagnoses were lobular carcinoma, not otherwise specified. Pathologic diagnoses were lobular SRCC. Signet-ring cells were mostly ICL type. In case 5, most carcinoma cells on the smears showed signet-ring features (non-ICL type), suggesting SRCC. The histologic diagnosis was lobular SRCC, and signet-ring cells were mostly non-ICL type. CONCLUSION: Ductal SRCC yielded more cellular smears as compared with lobular SRCC; therefore, cytologic diagnosis was easier in the former.     

Carcinoma of the penis--appraisal of a modified tumour-staging system

OBJECTIVE: To determine the effect of double immunostaining in the differential diagnosis of the benign vs. malignant nature of breast lesions with fine needle aspiration results. STUDY DESIGN: The study group consisted of 26 samples aspirated from patients with borderline breast lesions. RESULTS: Direct immunostaining by means of monoclonal antibodies directed against individual intermediate filament proteins keratin 8 and 17 revealed that the percentage of K8+K17+ cells in material from patients with fibrocystic disease and fibroadenoma significantly exceeded that found in carcinoma specimens. The diagnoses were confirmed histologically. CONCLUSION: The quantitative method applied in the analysis of double-immunostained cytologic aspirates is recommended for the differential diagnosis of the benign vs. malignant nature of breast lesions in borderline cases.     

Bronchoalveolar carcinoma: histopathologic study of evolution in a series of 105 surgically treated patients

BACKGROUND: Liposarcoma arising within a phyllodes tumor is extremely rare. To the best of our knowledge, a malignant phyllodes tumor with liposarcomatous stroma diagnosed by fine needle aspiration (FNA) has not been reported before. CASE: A 39-year-old female had a malignant phyllodes tumor with liposarcomatous stroma diagnosed by FNA cytology. Two subtypes of liposarcomatous stroma, including lipomalike differentiated and myxoid, were found in the aspirates. The cytologic findings were very representative of the histologic features. CONCLUSION: It is very important to recognize the cytologic features of such rare tumors. An accurate diagnosis preoperatively by FNA permits better therapy planning.     

Immunoglobulin-complexed aspartate aminotransferase

We reviewed our experience with 9,726 cases of fine-needle aspiration cytology of the breast that were done from January 1983 to February 1992. During our review, we found that 214 aspirates had been submitted from pregnant and lactating women for the investigation of breast mass(es). Despite a variable clinical presentation and spectrum of cytologic findings, we considered the application of aspiration cytology in these women as useful as in the nonpregnant-nonlactating women for management decision. A team approach between the clinician and cytopathologist was always maintained; with this approach, the false-positive or -negative diagnoses were reduced to almost nil. In all cases in which the cytodiagnosis of carcinoma of breast was made, the findings corresponded with subsequent cell blocks from the aspirate and tissue examination. Benign lesions were diagnosed cytologically with minimal difficulty, and all aspirates that were less than optimal for cytodiagnosis were repeated to minimize the chance of missing an abnormality. All the benign lesions were followed throughout pregnancy, postpartum, and thereafter; if the mass persisted, the aspiration was repeated. With this protocol of follow-up, the need for a customary liberal surgical biopsy was reduced to a minimum.     

Amygdalar volume and emotional memory in Alzheimer's disease

The cytologic diagnosis of follicular variant of papillary thyroid carcinoma (FVPTC) can be difficult owing to the paucity of nuclear changes of papillary carcinoma and overlapping features with other follicular-derived lesions. We report our fine-needle aspiration (FNA) experience with 17 histologically proved cases of FVPTC with a preceding FNA. All cases showed increased cellularity and a background of moderate to abundant thin watery colloid with variable amounts of thick eosinophilic colloid. The cells were arranged mainly in monolayer sheets and syncytial fragments; occasional microfollicle formation with abundant fine eosinophilic cytoplasm was seen. Nuclear enlargement was a consistent finding in all cases. Only 5 cases showed prominent nuclear features of papillary carcinoma. Histologic examination showed encapsulated follicular-patterned nodules with multifocal random distribution of nuclear features of papillary carcinoma that were more pronounced in the subcapsular locations of the lesions. This morphologic heterogeneity explains the variability seen in FNA specimens of FVPTC and may result in false-negative diagnoses. We believe that these findings should be considered when interpreting follicular lesions; suspicion of an FVPTC should be conveyed in the cytopathology report, which may prompt intraoperative assessment to avoid a second surgical intervention for completion thyroidectomy.     

Ki-ras mutations and the carcinoembryonic antigen level in fine needle aspirates of the pancreas

OBJECTIVE: To evaluate the sensitivity and specificity of the carcinoembryonic antigen (CEA) immunoassay and Ki-ras genotyping as adjuncts to the cytologic diagnosis of pancreatic fine needle aspirates (FNAs). STUDY DESIGN: A retrospective study of 30 patients with pancreatic masses evaluated with CEA immunoassay and gel or hybridization analysis of allele-specific polymerase chain reaction for mutant Ki-ras (codons 12 and 13). DNA was isolated from fixed, paraffin-embedded samples. Diagnoses were correlated with cytologic evaluations and patient outcome. RESULTS: Diagnoses included 17 pancreatic carcinomas, 3 other malignancies and 10 benign lesions. Sixty-five percent of all FNAs had mutated Ki-ras, and 42% of samples with altered Ki-ras had multiple mutations. Replicate FNA samplings in five of six patients had concordant genotypes. Sensitivities for diagnosis were as follows: cytology alone, 76%; CEA alone, 82%; Ki-ras alone, 82%; cytology plus CEA, 100%; cytology plus Ki-ras, 94%. Although specificities for Ki-ras (30%) and CEA (50%) individually were low, elevated CEA level and mutated Ki-ras in a sample with negative cytology strongly indicated false negative cytology. CONCLUSION: The addition of either or both the CEA assay and Ki-ras mutation analysis enhances the sensitivity of the cytologic diagnosis of pancreatic carcinoma by FNA.     

Prolonged immunodepression after trauma and hemorrhagic shock

OBJECTIVE: To define and discuss the cytologic findings in six cases of nodular pseudoangiomatous stromal hyperplasia (PASH) of the breast. STUDY DESIGN: Retrospective evaluation of the medical records, cytologic and histologic material from six patients with palpable mammary PASH. Cases in which PASH was associated with other predominant mammary lesions were not included in the study. RESULTS: A total of six patients with histologically proven PASH underwent aspiration in nine occasions (three patients studied twice). Clinically, five patients were diagnosed as having fibroadenoma or another benign lesion, and in one patient carcinoma was suspected. In two patients, mammography disclosed rapid growth of the lesion. Seven aspirations, performed on five patients, were diagnosed as fibroadenoma (n = 5) or fibroadenomatous lesion (n = 2). An eighth aspiration was cystic and reported as fibrocystic disease. The last case was erroneously diagnosed as suspicious for carcinoma. Even after revision, the cytologic similarities of PASH with fibroadenoma were remarkable. Most smears were less cellular than those of conventional fibroadenomas. Epithelial clusters showed variable size, with a predominance of medium to small groups. Stromal elements were minimal or absent. Background cellularity was composed of round to oval naked nuclei and others with spindle shapes. Occasional epithelial clusters showed cellular dissociation and slight atypia. CONCLUSION: Due to the absence of specific cytologic features and similarities to fibroadenoma, a precise diagnosis of PASH cannot be made on cytologic material. However, the majority of cases can be diagnosed correctly as benign, allowing appropiate treatment.     

Fine needle aspiration diagnosis of malignant mixed tumor (carcinosarcoma) arising in pleomorphic adenoma of the salivary gland. A case report

BACKGROUND: True malignant mixed tumor (carcinosarcoma), composed of carcinoma and sarcoma components, is rare in salivary gland neoplasms. Even rarer is a true malignant mixed tumor arising in the pleomorphic adenoma of the salivary gland. CASE: A 64-year-old male was admitted with left pharyngeal pain. Head and neck magnetic resonance imaging revealed a left parapharyngeal mass; fine needle aspiration (FNA) cytology through the oral cavity was performed. CONCLUSION: The aspirate presented a mixture of large, pleomorphic, vacuolated, single or multinucleated cells in a mucoid matrix and clusters of adenocarcinoma cells. Additionally, occasional benign glandular cells were noted. A cytologic diagnosis of malignant mixed tumor arising in the pleomorphic adenoma of the deep lobe of the parotid gland was made and confirmed by the surgically resected specimen.     

The accuracy of breast ultrasound in the evaluation of clinically benign discrete, symptomatic breast lumps

INTRODUCTION: Recent reports have suggested that breast ultrasound (US) is of value in distinguishing malignant from benign processes. The aim of this study was to establish the accuracy of US in detecting invasive malignancy in clinically benign, discrete, symptomatic breast lumps. METHODS: The US appearances of 205 clinically benign breast masses were documented prospectively and prior to mammography by one radiologist (AJE). The US appearances were then correlated with the fine needle aspiration (FNA), core biopsy and surgical findings and compared with the mammographic findings. RESULTS: The US findings were normal 72 (35%), simple cyst 63 (31%), solid benign 51 (25%), solid indeterminate 15 (7%) and solid malignant four (2%). Ultrasound characterized 13 (93%) of the 14 patients found to have invasive carcinoma as indeterminate or malignant. No patients with normal or simple cyst US findings had invasive malignancy. Ultrasound had significantly better accuracy (97% vs 87%, P < 0.02) sensitivity (93% vs 57%, P < 0.05) and negative predictive value (99% vs 92%, P < 0.002) than mammography in the detection of invasive carcinoma when indeterminate and malignant imaging findings were taken as positive. CONCLUSION: US is a useful adjunct to FNA/core biopsy in confirming the nature of symptomatic, clinically benign breast masses and is superior to mammography in this clinical setting.     

Cytologic diagnosis of pancreatic cystic lesions. A prospective study of 28 percutaneous aspirates

PURPOSE: To prospectively evaluate fine needle aspiration biopsy (FNAB) of pancreatic cystic lesions. STUDY DESIGN: We performed a blind, prospective study on percutaneous aspirates from 28 radiographically identified cysts, including 6 inflammatory cysts (5 pseudocysts and 1 abscess), 4 serous cystadenomas, 1 cystic islet cell tumor, 5 mucinous cystic neoplasms, 6 mucinous cystadenocarcinomas and 6 nonpancreatic cysts. RESULTS: Four of six (67%) cystadenocarcinomas were identified as malignant, and the other two, which lacked sufficient morphologic criteria for malignancy, as consistent with mucinous cystic neoplasm. Two of five mucinous cystic neoplasms were correctly classified. One, which contained atypical cells, did not appear to be mucinous on the ThinPrep, and one, which lacked an epithelial component, was suggested because of the presence of mucin in the background. The fifth one contained inflammatory cells only. One of four serous cystadenomas produced a diagnostic specimen. FNAB of the cystic islet cell tumor was nondiagnostic. Five of six inflammatory cysts (83%) were correctly diagnosed, whereas one case produced an acellular, nondiagnostic specimen. Six of 28 (23%) cases were nonpancreatic cysts, aspirated under the presumption that they were pancreatic cysts based on radiologic studies: only one case, a papillary cystadenocarcinoma of the stomach, was correctly diagnosed; the other five cases were nondiagnostic, and in two of these the assumption that the cysts were pancreatic in origin precluded an accurate classification. CONCLUSION: FNAB of pancreatic cystic lesions can differentiate mucinous from nonmucinous pancreatic cysts and provide definitive evidence of malignancy. In some cases, serous cystadenomas can be diagnosed. Pseudocysts can be suspected on the basis of an inflammatory smear lacking both epithelial cells and background mucin, but this finding is not specific. Nonpancreatic lesions constitute a significant percentage of cases aspirated as pancreatic cysts and present a major pitfall in cytologic interpretation.     

Detection of heterozygosity loss in microdissected fine needle aspiration specimens of breast carcinoma

OBJECTIVE: To use the polymerase chain reaction (PCR) to detect loss of heterozygosity (LOH) in microdissected cells form cytologic smears obtained by fine needle aspiration (FNA) from 20 cases of invasive breast carcinoma. STUDY DESIGN: In each case, histologic sections of the primary tumor were also available. Tumor and nontumor cells were dissected from both the cytologic smear and tissue section in all cases except in three smears that showed only tumor cells. RESULTS: LOH was identified in 10 of 19 informative cases using two polymorphic DNA markers at chromosome 11q13 (INT-2, PYGM). The same results were obtained in both the cytologic and histologic specimens, including three cases that had hypocellular cytologic smears. CONCLUSION: FNA of breast lesions provides adequate samples for direct microdissection of the cytologic smear to detect LOH using PCR amplification.     

Cytologic nuclear grade of malignant breast aspirates as a predictor of histologic grade. Light microscopy and image analysis characteristics

OBJECTIVE: To determine if cytologic nuclear grade characteristics combined with image analysis assessment of morphometric nuclear parameters (1) correlate with the modified Scarff-Bloom-Richardson grading system and (2) discriminate between low and high nuclear grades of invasive ductal carcinoma. STUDY DESIGN: Fifty-four fine needle aspiration biopsies (FNABs) of breast carcinoma were evaluated for five morphologic nuclear grade characteristics. In addition, four morphometric, standardized object measurements were analyzed by an image analysis system. Corresponding biopsies of invasive ductal carcinoma (46 cases) were independently evaluated with the Scarff-Bloom-Richardson grading system, modified into low (scores 3-6) and high (scores 7-9) grades. RESULTS: An overall agreement of 82% was reached by three of four cytopathologists for each of five morphologic characteristics. There was a strong correlation (r = .8059, P < .0001) between cytologic nuclear grade and modified histologic grade. Only pleomorphism, nucleoli and sum optical density retained their statistical significance in distinguishing low from high grade ductal carcinomas. These three characteristics also had the strongest correlation with cytologic nuclear grade. CONCLUSION: Cytologic nuclear grade from aspirates of ductal carcinoma can be a predictor of the modified histologic grades of Scarff, Bloom and Richardson. Nuclear morphology reinforced by image morphometry may separate these tumors into low and high nuclear grade categories.