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Title:
Fine Needle Aspiration Cytology of Seromas of the Breast from Irradiated Lumpectomy Sites
Authors:  Raj K. Gupta, M.D., F.I.A.C., David Gaskell, F.R.C.S., F.R.A.C.S., Carl Dowle, F.R.C.S., F.R.A.C.S., Sarla Naran, B.Sc., C.F.I.A.C., Sharda Lallu, B.Sc., C.F.I.A.C., and Robert Fauck, C.T.(IAC)
  Objective:: To study the cytologic features of cells in breast aspirates of seromas in women who had undergone irradiation at lumpectomy sites. Study design: Cytologic material from 38 females with an age range of 39-72 years who had undergone aspiration of seromas were retrieved to determine tumor recurrence or other atypia. The material was obtained using the conventional method of needle aspiration with a 22-gauge needle and 10-mL syringe, maintaining negative pressure. The syringe and needle contents were washed in a cytology container containing 30% ethyl alcohol in physiologic saline. From half the washings filter preparations were made and stained by the Papanicolaou method, while from the other half cell blocks were made and sections cut after processing and stained with hematoxylin-eosin.
Results:
: In 2 of 38 patients, filter preparations and cell blocks showed malignant cells of breast carcinoma that were similar to the primary. This was confirmed on core biopsy and subsequent mastectomy. In 21 of 38 cases mildly atypical cells with degenerative effects, mild hyperchromasia, liberal cytoplasm, macrophages, inflammatory cells and a few apocrine cells were seen, while in 11 of 38 patients scanty debris, few inflammatory cells, rare apocrine cells and a few macrophages were found. In 4 of 38 cases highly atypical cells with hyperchromatic nuclei and nucleoli were noted. However, a core biopsy in all 4 patients revealed no evidence of residual tumor.
Conclusion:
: Cell atypia in aspirates from seromas should be interpreted with caution to avoid unnecessary, invasive surgery, keeping in mind that radiation can cause misleading changes. However, patients with clinical indications of recurrent tumor or with severe atypia should undergo biopsy to permit appropriate management. (Acta Cytol 2004;48:478-480)
Keywords:  breast neoplasms, lumpectomy, radiotherapy, aspiration biopsy, seroma
   
   
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