In the initial evaluation of breast lumps, Fine Needle Aspiration (FNA) is a proven diagnostic technique. Aim of the study is to grade the infiltrating ductal carcinoma of breast by both cytologically and histologically and to correlate its grading. A total of 44 cases with a cytological diagnosis of invasive ductal carcinoma subsequently proved on histology were studied. These were graded according to Robinson’s cytological grading (RCG) and Elston’s modification of Bloom Richardson’s histological grading system. Statistical analysis was done using χ² test. Multiple regression analysis was done to assess the significance of each cytological and histological parameter. There were 22(50%), 19(43.1%) and 3(6.8%) cases of grade I, II and III ductal carcinomas respectively graded cytologically and 19(43.2%), 20(45.5%) and 5(11.4%) cases of ductal carcinomas graded I, II and III histologically. Overall, in 37 cases (84%) the cytological grade correlated with the histological grade and in 7 cases (18%) discrepancy was noted. There was a significant association (p<0.05) between the cytological and histological grading. This study showed that the extent of cell size, cell uniformity, nucleoli were the most influential features. 68% of grade I tumors 53% of grade II and 100% of grade III tumors showed lymphnode metastasis. Lymph node metastasis was seen irrespective of the grade of the tumor. To conclude grading act as powerful predictor of tumor aggressiveness; should thus be addressed in pathological analysis of breast carcinoma as it is simple and feasible.

Keywords: Breast carcinoma, Cytological grading, Cytohistological correlation, Histological grading.                      

1. Murthy NS, Chaudhry K, Nadayil D, Agarwal UK, Saxena S. Changing trends in incidence of breast cancer: Indian scenario. Indian J Cancer 2009; 46:73-4.
2. Bhatt JV, Shah JM, Shah FS. Pathophysiology of breast lesions: vision beyond the clinical eye. J Appl Basic Med Sci 2002; 4:81-4.
3. Khan N, Afroz N, Rana F, Khan MA. Role of cytologic grading in prognostication of invasive breast carcinoma. J Cytol 2009; 26(2): 65-8.
4. Wani FA, Bharadwaj S, Kumar D, Katoch P. Cytological grading of breast cancers and comparative evaluation of two grading systems. J Cytol 2010; 27(2):55-8.
5. Sinha SK, Sinha N, Bandyopadhyay R, Mondal SK. Robinson’s cytological grading on aspirates of breast carcinoma: Correlation with Bloom Richardson’s histological grading. J Cytol 2009; 26(4):140-3.
6. Robinson IA, McKee G, Nicholson A, D’Arey J, Jackson PA, Cook MG, et al. Prognostic value of cytological grading of fine-needle aspirates from breast carcinomas. Lancet 1994; 343:947-9.
7. Latinovie L, Heinze G, Birner P, Samonigy H, Hausmaninger H, Kubista E et al. Prognostic relevance of three histological grading methods in breast cancer. Int J Oncol 2001;19:1271-7.
8. Simpson JF, Grey R, Dressler LG, Cobau CD, Falkson CI, Gilchrist KW et al. Prognostic value of histologic grade and proliferative activity in axillary node positive breast cancer: Results from Eastern Cooperative Oncology Group Comparision Study EST4189. J Clin Oncol 2000;18:2059-69.
9. The uniform approach to breast Fine-needle aspiration biopsy. National Cancer Institute Fine-Needle Aspiration of Breast Workshop Subcommittees. Diag Cytopathol 1997; 16(4):295-311.
10. Hemachandran M, Nijhawan R, Joshi K. Cytological grading, apoptosis and Bcl-2 protein expression in breast cancer. Diagn Cytopathol 2002; 26:356-9.
11. Khan MZ, Haleem A, Al Hassani H, Kfoury H. Cytopathological grading, as a predictor of histopathological grade, in ductal Carcinoma (NOS) of breast, on air-dried Diff-Quick smears. Diagn Cytopathol 2003; 29:185-93.
12. Robles-Frias A, Gonzalez-Campora R, Martinez-Parra D, Robles-Frias M, Vazquenz-Cerezuda T, Otal-Salaverric, et al. Robinson cytologic grading of Invasive Ductal Breast Carcinoma Correlation with Histologic Grading and regional lymph node metastasis. Acta Cytol 2005; 49:149-53.
13. Meena SP, Hemrajani DK, Joshi N. A Comparative and evaluative study of cytological and histological grading system profile in malignant neoplasm of breast - an important prognostic factor. Indian J Pathol Microbiol 2006; 49(2):199-202.
14. Sultana T, Rahman AJ. Cytological grading of duct cell carcinoma, NOS of breast and its correlation with histological grading. Bangladesh Med Res Counc Bull 2006; 32(2):49-54.
15. Rekha TS, Nandini NM, Dhar M. Validity of Different Cytological Grading Systems of Breast carcinoma - a Hospital - based Study in South India. Asian Pacific J Cancer Prev2011; 12:3013-6.
16. Das AK, Kapila K, Dinda AK, Verma K. Comparative evaluation of grading of breast carcinomas in fine needle aspirates by two methods. Indian J Med Res 2003; 118:247-50.
17. Chhabra S, Singh PK, Agarwal A, Bhagoliwal A, Singh SN. Cytological Grading of Breast Carcinoma-A Multivariate Regression Analysis. J Cytol 2005; 22(2):62-5.
18. Pandit AA, Parekh HJ. Cytologic grading of breast carcinoma. Comparison of four grading systems. J Cytol 2000; 17:39-44.
19. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status and survival in 24,740 breast cancer cases. Cancer 1989; 63:181-7.
20. Taniguchi E, Yang Q, Tang W, Nakamura Y, Shan L, Nakamura M, et al. Cytologic grading of invasive breast carcinoma. Correlation with clinicopathologic variables and predictive value of nodal metastasis. Acta Cytol 2000; 44:587-91.
21. Dash A, Mohanty R, Mallik R, Dash K. Aspiration smear pattern as a predictor of biological behavior in breast carcinoma. J Cytol 2005; 22:19-21.

Dr B Nagaraja

Associate Professor, Department of Pathology, Government Medical College, Kadapa, India