Histologic Analysis Histologic evaluation with hematoxylin and eosin (H&E) staining confirms benign or malignant disease. Images of benign and malignant breast lesions can be viewed through the Internet Pathology Laboratory for Medical Education (79). Assessment of prognostic factors, tumor grade; estrogen, progesterone, her-2/neu receptor status; and proliferative indices is performed on paraffin-fixed tissue by immunohistochemistry (78). Her-2/neu assessment in breast cancer by immunohistochemistry (IHC) is appropriate for patients with tumors that score 3+. Fluorescence in situ hybridization (FISH) is recommended for 2+ IHC to more accurately assess her-2/neu amplification and provide better prognostic information (80).
Ductal Lavage Cytology Ductal lavage using a microcatheter is a modality that was investigated in high-risk women (81). Patients undergo gentle nipple suction to elicit nipple ﬂuid. A duct that yields ﬂuid is cannulated with a microcatheter, and 10 to 20 mL of saline are introduced in 2-to 4-mL increments. The cytologic assessment of a sample obtained by ductal lavage is more sensitive than that of nipple aspiration. Ductal lavage performed to identify abnormal cells is not an effective tool in detecting breast cancer and is rarely performed (81).
Benign breast disorders account for most breast problems. These conditions are frequently considered in the context of excluding breast cancer and often are unrecognized for their own associated morbidity (82). To provide appropriate management, it is important to consider benign breast disorders from four aspects: (i) clinical picture, (ii) medical significance, (iii) treatment intervention, and (iv) pathologic etiology (83). A framework for understanding benign breast problems is called Aberrations of Normal Development and Involution (ANDI) (2,82,83). It includes symptoms, histology, endocrine state, and pathogenesis in a progression from a normal to a disease state. Most benign breast conditions arise from normal changes in breast development, hormone cycling, and reproductive evolution (82).
Three life cycles reﬂect different reproductive phases in a woman’s life and are associated with unique breast manifestations.
1.
During the early reproductive period (15–25 years), lobule and stromal formation occurs. The ANDI conditions associated with this period are fibroadenoma (mass) and juvenile hypertrophy (excessive breast development). In this first stage, the progression from ANDI to a disease state results in the formation of giant fibroadenomas and multiple fibroadenomas.
2.
During the mature reproductive period (25 to 40 years), cyclic hormonal changes affect glandular tissue and stroma. In this second period, the ANDI is an exaggeration of these cyclic effects, such as cyclic mastalgia and generalized nodularity.
3.
The third phase is involution of lobules and ducts or turnover of epithelia, which occurs during ages 35 to 55 years. The ANDI associated with lobular involution are macrocysts (lumps) and sclerosing lesions (mammographic abnormalities). Those associated with ductal involution are duct dilation (nipple discharge) and periductal fibrosis (nipple retraction), and those with epithelial turnover are mild hyperplasia (pathologic description).
Disease conditions with increased epithelial turnover are epithelial hyperplasias with atypia. Breasts are under endocrine control and show a wide range of appearances during reproductive life. ANDI classification allows the clinician to understand the pathogenesis of these conditions and to understand that these disorders are aberrations of a normal process that does not usually require any specific treatment (82).