To identify prognostic indicators in breast cancer patients with malignant pleural effusions, we analyzed the cytopathologic features of 57 fluids representing the first pathologic diagnosis of a distant metastasis in these women. The specimens were analyzed prior to reviewing the clinical records. The median survival of 55 patients who died of the disease was five months following the effusion diagnosis (range, 1-114). Univariate analysis identified three cytopathologic features that correlated with relatively prolonged survival: arrangement of tumor cells in spheroids, slight nuclear atypia and low mitotic rate. Women whose tumor cells formed spheroids survived a median of 24.5 months as compared to 4 months for women with all other architectural patterns (P = .004). Multivariate analysis revealed that slight nuclear atypia and low mitotic rate strongly correlated with spheroid formation. Since breast cancers that form spheroids in effusions portend a relatively favorable prognosis, we recommend that cytopathologists comment on this pattern when reporting on metastatic breast carcinoma in pleural fluids.
Immunocytochemical study of cytologic specimens is often limited by the number of slides containing diagnostic cells. This study examined the effectiveness of transferring cells from a single smear to multiple slides in order to perform a battery of immunocytochemical stains on limited material. Immunostaining performed on four effusions and five fine needle aspirates yielded the expected results for most of the antibodies commonly employed in diagnostic pathology. Background staining was generally low following cell transfer, and the morphology of the cells was preserved. These results suggest that cell transfer in combination with immunocytochemistry may prove useful in the cytologic diagnosis of malignant lymphoma, neuroendocrine neoplasms, prostatic and mammary adenocarcinoma, and other malignant tumors.
