Expression of Estrogen, Progesterone Receptors and MNF 116 Markers in Breast Fine Needle Aspiration: A comparison betweendirect smear and cell block

Abstract

This is a comparative longitudinal study carried out at Radio Isotope Khartoum Center during the period from July 2005 to 2007. The study aimed at screening for breast cancer among those present with breast lumps, as well as assessing of immunostaining in cytological preparations. Two hundreds Patients with breast lumps were investigated using conventional Fine needle aspiration cytology FNAC, cell block and Immunocytochemistry ( Identifying Estrogen ER, Progestrone PR and cytokeratin MNF116 markers). Of the 200 patients 61 (30.5%), 5 (2.5%) and 2 (1%) were diagnosed as having malignant change, highly suspicious of Malignancy and atypical aspirate respectively. The remaining 132 (66%) were found with different benign conditions with predominantly fibroadenoma followed by fibrocystic change, inflammatory lesions and benign cysts constituting 56 (42.4%), 23 (17.4%), 22 (16.7%) and 12 (9.1%) in this order. Of the 61 cancerous specimens, only 32 specimens had afforded a satisfactory specimen for immunostaining. Of the 32 stained smears 28 (87.5%), 25 (78%) and 26 (81%) specimens were found positive, by ER, PR and cytokeratin MNF 116 respectively, in cell block. Direct smear had showed unfairly positive values, 28 (87.5%), 29 (90.6%), 30 (93.7%) for PR, ER and cytokeratin MNF 116 correspondingly. However, when assessing these positive smears according to their intensity of immunostaining. Intensity of (+++) was detected among 5 (15.6%) smears ER in cell block compared to 2 (6.3%) in direct smear. Additionally PR 4 (12.5%) and cytokeratin MNF 116 3 (9.4%) obtained (+ + +) by cell block compared to 3 (9.4%) in direct smear. - 6 - According to the study, combined direct smear and cell block preparation is an excellent approach in the diagnosis of breast cancer, as well as the in determination of ER, PR and cytokeratin MNF 116 expression. Cell block showed a better rectitude in direct interpretation of the results compared to direct smear, as well as superior staining quality. FNAC can be used to detect cytological atypia which is frequently encountered in pre-malignant and early malignant breast lesions. Patient’s age emerges as factor that needs increasing consideration when diagnosing breast cancer.