Comparative analysis of six cytological grading systems in breast carcinoma

Background: Fine-needle aspiration cytology (FNAC) gives the necessary information of various breast lesions for surgical management of patients and can be extremely useful for establishing the best neoadjuvant therapy in patients where surgical removal of tumor is not the best option. The National Cancer Institute, Bethesda sponsored conference recommended that the tumor grading on FNAC should be incorporated in reports for prognostication. Objective: The purpose of this study is to determine the correlation between cytomorphologic and histomorphological features and to evaluate the utility of different cytological grading systems and to determine which cytology grade corresponds best to the histology grade. Materials and Methods: The present prospective study included fifty cases of breast carcinoma diagnosed on FNAC and confirmed on histopathology. Detailed cytomorphological features were studied. Cytology grading was done using six grading systems. Detailed histological features were studied, and carcinomas were graded as per modified Scarff-Bloom-Richardson's histopathological grading system. Cytology grading was correlated with histology grading. Results: Out of fifty cases of breast carcinomas, the 29 (58%) cases of each Robinson's cytological grading and Fisher's modification of Black grading correlated with histological grading. The cytological features, namely, nuclear chromatin, nuclear pleomorphism, cell size, nuclear margins, and naked tumor nuclei used in grading correlated well with histological grade. Conclusion: Cytology grading adds to objectivity, reproducibility, and authenticity to the report. The cytology features such as nuclear chromatin, nuclear pleomorphism, cell size, nuclear margins, and naked tumor nuclei had influential role in predicting the final cytology grade. Among the six cytology grading systems, Robinson's system is simple to interpret, more objective, takes less time, and is reproducible and correlates precisely with histological grade as evident from our study. It should be used for routine evaluation of aspirates of breast carcinoma.