Valoración pronóstica del carcinoma ductal infiltrante mamario en PAAF. Estudio comparativo de tres sistemas de graduación citológica

We have evaluated three different systems of cytologic grading based in morphological parameters in order to define the Cytological Grade (CG) making a correlation with the Histological Grade (HG), Histological Cytological Grade (HCG) and the Histological Mitotic Index (HMI) in 366 FNA biopsies from surgical specimens of the breast without fixation diagnosed as invasive ductal carcinoma. The sensitivity and specificity of the grading systems used to define CG1 fluctuate between 91.9% and 95.2% and 89.3% and 98.2%, respectively. They are between 88.4% and 80.6% and 90.7 and 95.4% in the definition of CG3. Anisocariosis index, cellular grouping, nuclear membrane irregularity and the presence or absence of mitotic figures are the parameters that correlate with the HG showing the best statistic signification. Excluding parameters are important in order to define the CG. The correlation between CG and HCG is good in almost every case but the one established between CG and HMI is valid only in the group with lower grade. We have not classified improperly grade tumours as high grade tumours and vice versa. The erroneous classification of tumours of low grade as intermediate grade and these as high grade tumours are in the range referred in the literature.