Automatic Image Cytometry DNA-ICM In Breast Fine Needle Aspiration Cytology

Objective: Breast cancer is the most common malignant disease of women.Recently,the incidence rate of breast cancer is sharp rising in China,especially in big citys. Early diagnosis count significantly to the improvement of survival of the patients,and the FNAC is used for the early diagnosis frequently. This study aimed to analys sensitivity,specificity,positive accuracy,positive predictive value,negative predictive value of breast fine needle aspiration cytology (FNAC) and Automatic DNA Image Cytometry (DNA-ICM) system,to explore the value of ICM in the diagnosis of FNAC,to explore the correlation of DNA content with the expression of antigen Ki-67 and clincopathologic features ,for provide evidence for breast cancer of diagnosis and prognostic evaluation.Materials and Methods: 95 women with breast mass of the Fourth Hospital of Hebei Medical University, Department of Pathology Cell Room during 2009 September and 2010 January,no preoperative radiotherapy and chemotherapy, and no transfer to other organs, cell smears were made by needle aspiration. Postoperative pathology confirmed 74 cases of infiltrating ductal carcinoma, 5 cases of invasive lobular carcinoma, 1 case of invasive lobular, mixed ductal breast cancer, 2 cases of acinar cell carcinoma, 1 case of medullary carcinoma, 8 cases of breast adenosis, 1 case of breast fibroadenoma, 2 cases of intraductal papilloma, 1 case of fat necrosis.In 95 cases , enough cells were pumped, evenly applied to six slides.Then the six slides were randomly divided into three groups, two slides in each group and half-wet fixed, 95% ethanol fixation for smear cytology and cytologicimmunology (cell proliferation marker Ki-67), anhydrous ethanol fixation for detection of DNA ploidy. Fine needle aspiration smears were stained with Papanicolaou for the description of diagnostic cytopathology. In DNA-ICM test the fine needle aspiration smears were stained with Feulgen, and placed in automatic image analysis microscope, manual tuning to the 20×objective lens, auto-focus, auto scan, and then the vision were divided into 1080 small areas. The data was recorded after each area was scaned. The classified parameters, geometric parameters, image parameters and other parameters of all cells were measured automatically on each slide, Histogram was given, that horizontal axis is the IOD values, vertical axis is the cell number, nuclear area distribution picture was given, that the horizontal axis is the IOD values, vertical axis is the nuclear area,Average DI values, standard deviation, coefficient of variation were given, IOD values in the top 20 highest DNA content and the microscope image pictures of all scan cells were given.To investigate the expression of antigen Ki-67 of fine needle aspiration cytology(FNAC) by immunocytochemical methods, while clollect clinical data and postoperative pathological data.Results: ICM showed a large number of cells of abnormal DNA ploidy in 48 cases of breast cancers dignosed by FNAC, and histopathology confirmed. 22 cases of FNAC diagnosis were severe proliferation of mammary epithelial cells, of which 19 cases ICM showed abnormal DNA ploidy cells. These 22 cases were confirmed as breast cancers by pathology.11 cases were diagnosed as obvious hyperplasia of mammary epithelial cells by FNAC, of which 5 cases ICM showed abnormal DNA ploidy cells, 4 cases were confirmed of breast cancer by pathology and 1 case of intraductal papilloma. 14 cases of FNAC diagnosed as benign lesions, 1 case of DNA ploidy abnormal cells was seen in ICM, confirmed of Benign by pathology.The negative predictive value of FNAC diagnosis is batter than DNA-ICM system diagnosis (P <0.05); Both of FNAC and DNA-ICM diagnostic sensitivity, positive accuracy, positive predictive value are better than that of DNA-ICM (P <0.05); The combination diagnosis of FNAC and DNA-ICM is better than that of FNAC, but not statistically significant (P> 0.05).With the increasing level of cell proliferation, DI mean increased. DNA content was significant different between severe proliferation of mammary epithelial cells and significant hyperplasia of the mammary epithelial cells (P <0.05), between breast cancer cells and severe hyperplasia of the mammary epithelial cells(P <0.05). With increasing classification of expression of antigen Ki67, DNA content increased, and the increase in DNA content was statistically significant (P <0.05). Postoperative pathology showed that DNA content was significantly correlated with tumor size and histological grade (P <0.05), but the DNA content was not significantly correlated with the age and axillary lymph node metastasis (P> 0.05).Conclusion:1 The DNA-ICM and FNAC could diagnose most of breast diseases identically. DNA-ICM is helpful for FNAC diagnosis.2 The diagnostic indicators of DNA-ICM are not better than that of FNAC, but both DNA-ICM and FNAC diagnosis are better compared with single diagnosis of them.3 DI value is increased with the increasing cytological grades and the expression of antigen Ki-67, indicating that DNA-ICM can show cell proliferation degree quantitatively.4 DNA content is not related with the age and axillary lymph node metastasis; DNA content is related with the tumor size, histological grade. Large breast mass size, high histological grade, and high DNA content indicats a large malignant tumor with poor prognosis.