Burcu Özcan, Ayşenur Başkan
İstanbul Medical Journal - 2026;27(2):155-158
Introduction: Papillary lesions of the breast constitute a heterogeneous group ranging from intraductal papillomas to papillary carcinomas. Fine-needle aspiration cytology (FNAC) plays an important role in the initial evaluation of these lesions; however, cytologic distinction between benign and malignant papillary lesions is challenging due to overlapping morphologic features. The aim of this study was to determine the diagnostic value of cytologic findings and the associated risk of neoplasia (RON) and malignancy in papillary breast lesions. Methods: A total of 35 cases of breast FNAC and nipple discharge cytology that demonstrated papillary architecture (2017-2024) were retrospectively evaluated. Cytomorphologic assessment focused on two diagnostic features-nuclear atypia and hypercellularity-and their correlation with histologic outcomes. The RON and the risk of malignancy (ROM) were calculated with 95% confidence intervals (CIs). Statistical analysis was performed using Fisher's exact test. Results: All patients were female (age range: 25-71 years; mean: 47 years). Histopathologic diagnosis was available for 8 cases, and clinical follow-up for 17 cases. Nuclear atypia was identified in 5 cases (14%), while hypercellularity was observed in 17 cases (48.5%). RON and ROM were 60% and 20% in cases with nuclear atypia and 35.3% and 11.8% in cases with hypercellularity, respectively. Among all evaluable cases, overall RON was 32.0% (95% CI: 17.7-51.6) and ROM was 12.0% (95% CI: 4.2-30.0). Conclusion: FNAC remains a valuable and minimally invasive diagnostic tool in the evaluation of papillary breast lesions. Although definitive cytologic distinction between benign and malignant lesions is not always possible, the identification of nuclear atypia and hypercellularity serves as an important indicator of neoplastic potential. The integration of immunocytochemical studies and standardized reporting systems may further improve diagnostic accuracy and reproducibility in the cytological evaluation of papillary breast lesions.
