COMPARISON OF CYTOLOGIC FINDINGS OF NIPPLE DISCHARGE WITH GALACTOGRAPHIC FINDINGS

Abstract

Uvod. Jedan od simptoma raka dojke je i iscjedak iz dojki. Citološki nalaz hiperplastičnih stanica bez anizocitoze te s anizocitozom, eritrociti i maligne stanice u iscjetku indikacija su za daljnju obradu – galaktografijom. Galaktografija je kontrastna pretraga tijekom koje se kanalić iz kojega je dobiven iscjedak ispuni kontrastom i slika. Prema nalazu galaktografije indicira se operativni zahvat. Cilj rada. U radu se željelo pokazati kolika je podudarnost između boje iscjetka, citološkog nalaza te galaktografskog nalaza. Materijal i metode. U razdoblju od 01. 01. 1993.do 31. 12. 2007. godine, u Ambulanti za bolesti dojke Klinike za ženske bolesti i porode KBC-a Zagreb učinjena je nakon citološke obrade iscjetka 91 galaktografija. Citologija iscjetka prema kojoj je indicirana galaktografija bio je nalaz hiperplastičnih stanica, bez ili s anizocitozom ili eritrociti, odnosno kombinacija oba nalaza. Tijekom očitavanja galaktografije promatrana je širina i pravilnost grananja kanalića, uz analizu stijenke i defekata punjenja unutar kanalića. Ukoliko se našao defekt punjenja, nepravilna proširenja kanalića ili oboje, bolesnica je bila upućena na biopsiju. Rezultati. Prema boji iscjedak je bio podijeljen u 5 kategorija: serozni i mliječni iscjedak nađen je u po 10 bolesnica (22%), njih 29 (31,8%) imalo je obojeni iscjedak (zelenkast, smeđi, žućkast), u 2 (2,2%) bolesnice bio je gnojni iscjedak dok je najveći broj bolesnica, njih 40 (44%), imalo krvavi iscjedak. Citološkom analizom iscjetka dobiveni su sljedeći rezultati: samo eritrociti nađeni su u 18 (19,8%) bolesnica, 19 (20,8%) bolesnica imalo je u iscjetku papilarne nakupine hiperplastičnih duktalnih stanica, u 7 (7,8%) bolesnica nađene su papilarne nakupine duktalnih stanica i anizocitoza, a u 47 (51,6%) bolesnica uz eritrocite su nađene i papilarne nakupine hiperplastičnih stanica. Razlikovale su se tri kategorije galaktografskih nalaza: uredan nalaz (19 bolesnica, 20,8%), hiperplazija – proširenja kanalića uz neravnosti stjenke (56 bolesnica, 61,6%), te suspektan nalaz – defekti punjenja kanalića, izrasline (16 bolesnica, 17,6%). Bolesnice sa suspektnim nalazom, njih 16, bile su upućene na biopsiju. Patohistološki nalaz u operiranih bolesnica bio je: u četiri (25%) papilom, 10 (62,5%) bolesnica imalo je duktalnu hiperplaziju, a u dvije (12,5%) nađen je karcinom. Prosječna dob bolesnica u kojih je bila indicirana galaktografija je bila 48 godina, dok je u bolesnica s karcinomom bila 63 godine. Zaključak. Naši rezultati upućuju na dobru korelaciju citološkog i galaktografskog nalaza. Hiperplazija duktalnih stanica u citološkom razmazu potvrđena je galaktografski u 62,5% ispitanica. Citološki, u svih 16 bolesnica u kojih su nađeni eritrociti uz hiperplaziju, što je upućivalo na intraduktalni proces, nalaz je ujedno dokazan i galaktografski. Sve ove ispitanice imale su krvavi iscjedak već pri uzimanju uzorka.Introduction. Nipple discharge is one of the symptoms of the breast cancer. Hemorrhagic discharge are always arousing suspicion for intraductal process (papilloma, carcinoma). The cytologic finding of red blood cells, atypical ductal cells and malignant cells in the discharge are indication for further analysis – including galactography. Objective. The aim was to show connection between colours of nipple discharge, cytologic findings and galactographic findings. Materials and methods. During the period January 1, 1993 and December 31, 2007 91 galactography were performed in Outpatient Clinic for breast disease, Department Gynaecology and Obstetrics, University Hospital Zagreb. Galactography was performed after cytological analysis of the discharge. Indication for galactography was the presence of red blood cells and atypical duct cells or combination of both. During the reading we observed the width and irregularity of ducts branching together with analysis of the wall and defects of filling (charging) within the ducts. In case of some irregularities the patients were referred to the biopsy. Results. Discharge was divided into 5 categories according to the colour: colourless or serous discharge was found in ten patients (11%), the same number had milky discharge, the largest number, 29 (31.8%) had coloured discharge (greenish, brownish, yellowish) and in 2 (2.2%) purulent discharge was found while in 40 (44%) patients the discharge was bloody. Cytological analysis gave the following results: red blood cells alone were found in 18 (19.8%) of the patients, papillary hyperplastic duct cells were found in 19 (20.8%) of the discharges and tight papillary clusters with anisocytosis were found in 7 (7.8%) patients and in 47 (51.6%) patients together with red blood cells, tight papillary cluster cell groups were found. Galactographical findings were divided into three categories: normal (19 patients – 20.8%), hyperplasia – proliferation of ducts with roughness of the wall (56 patients – 61.6%), and suspicious – defects in filling of the duct, tumours (16 patients – 17.6%). Patients with suspicious findings, 16 of them, were referred to surgery. Pathohisiological finding was papilloma in 4 (25%) of the surgical specimens, 10 (62.5%) had duct hyperplasia and carcinoma was found in 2 (12.5%) patients. Conclusion. Our results show good correlation between cytological and galactographical finding. It has been noticed that the presence of hyperplasia of duct cells in cytological smear is connected with hyperplasic changes of the ducts in 62.5% of the patients. In all 16 patients where red blood cells together with duct cells hyperplasia were found, cytological finding indicated to intraductal process, the finding was at the same time proven galactographgically as well