Farooq Ahmed Wani, et al. Cytological grading of breast cancers and lymph node metastasis 906 International Journal of Medical Science and Public Health | 2014 | Vol 3 | Issue 8 RELATIONSHIP BETWEEN CYTOLOGICAL GRADING OF BREAST CANCERS AND LYMPH NODE METASTASIS Farooq Ahmed Wani 1 , Subhash Bhardwaj 2 , Dinesh Kumar 3 , Pervez Katoch 2 , Altaf Hussain Bandy 4 1 Department of Pathology, Aljouf College of Medicine, Sakaka, Saudi Arabia 2 Department of Pathology, Government Medical College, Jammu, India 3 Department of Community Medicine, Government Medical College, Jammu, India 4 Department of Community Medicine, Aljouf College of Medicine, Sakaka, Saudi Arabia Correspondence to: Farooq Ahmed Wani (wani_farooq786@yahoo.com) DOI: 10.5455/ijmsph.2014.190520141 Received Date: 14.05.2014 Accepted Date: 29.05.2014 ABSTRACT Background: Breast cancer is the second most common type of cancer and the second leading cause of cancer related deaths in females. Since a less invasive pre-operative diagnosis is always preferred to open biopsy, fine needle aspiration cytology has been frequently used to decide the benign or malignant nature of particular breast lesions. But many studies have shown that this technique can provide additional information about the intrinsic features of the tumours as well as their prognosis. Grading of breast carcinoma, while the tumour is still in vivo, would be the most ideal and desirable situation, as it would be helpful in the selection of patients for appropriate therapy. Aims & Objective: (i) To evaluate and compare the cytograding of breast cancers using Robinson’s and Mouriquand’s grading methods. (ii) To evaluate the relationship between cytograding of breast cancers and lymph node metastasis. Materials and Methods: A 5-year retrospective (from Oct 2000 to Sept 2005) and 1-year prospective study (from Oct 2005to Oct 2006). A total of 110 fine-needle aspiration cytology (FNAC) cases of breast cancers were graded by Robinson’s and Mouriquand’s grading methods followed by comparison of the two methods. Relationship between grading and lymph node metastasis was evaluated. Results: By Robinson’s method, 28 (25.45%) cases were grade I, 46 (41.81%) grade II and 36 (32.72%) were grade III whereas using Mouriquand’s method, 28 (25.45%), 42 (38.18%) and 40 (36.36%) cases were graded as grade I, II, and III respectively. A high degree of concordance was observed between the two grading methods (90.9%). A highly significant relationship between the scores obtained by two methods was also observed (P=0.004). By Robinson’s method, Grade I, II and III tumours had lymph node involvement in 3.57%, 6.52% and 47.22% of cases respectively whereas by Mouriquand’s method, Grade I, II and III tumours had lymph node involvement in 3.57%, 7.14% and 42.5% of cases respectively. Although both grading systems showed significant relationship with lymph node involvement but Robinson’s grading was a much better predictor of lymph node metastasis. Our study showed that greater cell dissociation was associated with higher incidence of regional lymph node metastasis. A highly significant relationship was observed between cell dissociation and lymph node involvement (p=0.00000). Conclusion: A comprehensive cytological grading of breast cancers is possible by using Robinson’s and Mouriquand’s method. A high degree of concordance was observed between the two methods but Robinson’s grading system was found to be easier and better because of more objective set of criteria and easy reproducibility. Cytological grading of breast cancers is a strong predictor of lymph nodal metastasis and greater cell dissociation is associated with higher incidence of regional lymph node metastasis. Key Words: Breast Cancer; Cytological Grading; Lymph Node Metastasis; Robinson’s Method; Mouriquand’s Method Introduction Breast cancer is the second most common type of cancer and the second leading cause of cancer related deaths in females. [1] Since a less invasive pre-operative diagnosis is always preferred to open biopsy, fine needle aspiration cytology has been frequently used to decide the benign or malignant nature of particular breast lesions. But many studies have shown that this technique can provide additional information about the intrinsic features of the tumours as well as their prognosis. [2] Grading of breast carcinoma, while the tumour is still in vivo, would be the most ideal and desirable situation, as it would be helpful in the selection of patients for appropriate therapy. [3] The degree of cell dissociation is an indicator of cell cohesion status and to an extent, of the degree of expression of the Cadherin molecules on the cell surface. [4] Loss of cell cohesion appears to facilitate vascular infiltration by tumour cells, which gives rise to an increased incidence of regional lymph node metastasis. Greater cell dissociation has been found to be associated with higher incidence of regional lymph node metastasis. [5] High cytological grade has also been found to be associated with nodal metastasis. [6] As we know regional lymph node metastasis can predict the outcome of disease, therefore, cytological grade is a useful tool for predicting the prognosis of the patient. Robles et al (2005) found that 3 out of 6 features of Robinson’s grading system (nuclear margins, cell uniformity and cell dissociation) displayed a positive RESEARCH ARTICLE