Reply to Robinson

✍ Scribed by Grace McKee; Andrea Abati

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 9 KB
• Volume: 20
• Category: Article
• ISSN: 8755-1039
• DOI: 10.1002/(sici)1097-0339(199903)20:3<184::aid-dc17>3.0.co;2-f

✦ Synopsis

In addition to the diagnosis of malignancy, typing of the tumor when feasible, 2 and nuclear/cytological grade, fine-needle aspiration cytology lends itself to numerous other investigations for the assessment of prognosis. These include preoperative evaluation on aspirates of tumor angiogenesis by vascular endothelial growth factor mRNA expression, 3 ploidy status, 4 evaluation of proliferation activity, 5,6 and the prediction of response to tamoxifen. 7 With the advent of preoperative chemotherapy for appropriate breast cancers, the material obtained from the original fine-needle aspirate assumes an ever-increasing role. There is now the added dimension of possibly bypassing surgical excision of lymph nodes and using other predictors of lymph node involvement in breast aspirates, such as the study of computer-derived nuclear features, 8 analyzing tumor-cell dyscohesion, 9 assessment of reduction in nm23 protein expression, 10 and of loss of integrin expression 11 as well as vimentin expression. 12 Current recommendations include not only nuclear/ cytologic grading, but also estrogen and progesterone status evaluation. 1 Additional studies are optional.

As expertise in the procurement of fine-needle aspirates increases, and the usefulness of various prognostic markers becomes evident, we cytopathologists should extract every possible morsel of diagnostic and prognostic information from cytological material. This will not only aid decision-making for neoadjuvant and adjuvant therapy but could also minimize the need for and extent of surgery.