The New Role of Cytomorphology from Ultrasound-Guided Fine Needle Aspiration Cytology in Evaluating the Status of Prognostic Factors Including Estrogen Receptor, Progesterone Receptor and HER2 in Breast Cancer

Abstract Purpose It is well established that estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (HER2) have therapeutic implications cand could be regarded as prognostic factors in breast cancer. Ultrasound-guided fine needle aspiration cytology (FNAC) has revolutionized the management of cancers, providing less invasive and quick diagnostic method. There are hardly studies on the correlation between cytomorphology and three prognostic markers. Methods We retrospectively analyzed the immunohistochemistry and fluorescence in situ hybridization of axillary lymph node specimen from 252 patients, who have been diagnosed as breast cancer at Sichuan Cancer Hospital. Morphologic features of cytology sections were scored. The relationship between cytological features and three markers were analyzed. Based on this, we developed a new system to predict the status of markers.Results The results indicated that some cytological parameters, especially the features of nucleoli, were distinctively related to the makers’ expression. In the new scoring system, a cutoff of 12.5 provided a statistical discrimination for cytological grading. Meanwhile, it was associated with higher sensitivity for evaluating the ER and PR status (94% and 86%, respectively), but a lower sensitivity for HER2 status (76%). Conclusions We concluded that cytomorphological features are associated with three prognostic factors. The HR+ tumors showed scattered micro-nucleoli, while HER2-amplication tumors demonstrated centered macro-nucleoli. Based on this, we summarized six parameters to form a new scoring system to predict the status of three factors. This may help us to broaden the application of breast cancer cytology.