Is this cancer ?

[pintoo]

My mother (60) had a lump in the right breast, The FNAC and
Ultra reports read as follows:

FNAC Report:
Site of aspiration : Right breast lump
Gross examination : FNAC of right breast breast lump yielded particulate meterial
Microscopic examination : Smears are extremely cellular. There are multiple clumps and dense population of ductal epithelial cells together with stromal fragments on the amorphous background. The predominant cells are benign in nature. However, few cells show mild nuclear atypia.
Diagnosis : Fibroadenoma with ? atypical ductal epitheliosis
Note : In view of age of the patient and above cytomorphology, an excisional biopsy is recommended to rule out earliest stage of ductal carcinoma

Ultrasonography
Right breast:
Parencymal echopattern of right breast appears to be within normal limits except an irregular outline hypoechoic SOL, measuring 1.9 X 1.2 cm in size - close to nipple (inner aspect) -suggesting neoplasia.

My questions -
a) What does the FNAC report mean ?
b) given these findings, what is the likelihood of
cancer ?
c) If it is cancer, is it likely to be DCIS/LCIS/invasive ?
d) Does the diagnosis of fibroadenoma look correct ? could it be a PT instead ?
e) The tumor has since been excised by Excisional Biopsy - given the above findings, was it too aggresive a step ?
f) What is the likely next step (if any) ? Will there be a need for sentinel node biopsy ?

Thanks in advance for all the answers!

[surgeon]

the terminology in general says, first, that the smear is a good sample: lots of cellularity means there's good sampling, as opposed to a sample with only a few cells. Epithelial cells are lining cells: skin is epithelium, so are the cells lining the inside of the ducts. It means the sample got lots of cells to look at, and they are lining type cells, which is the layer that cancer would come from, also. Finally, mild atypia means slightly abnormal: but such things are seen in many conditions. It means there are a few cells that aren't perfectly normal, but none that look like cancer cells. The bottom line is, the report in essense says the sample was a good one, there are no obviously malignant cells, the cells seen are mostly normal. In many cases, when a few atypical cells are seen, it's a good idea to do a bigger (ie, surgical) sampling to be sure there aren't malignant cells. It seems pretty likely that if an open biopsy is done, it'll turn out ok, based on the FNAC

[pintoo]

Dear poster,

Thanks for your reply. I knew what FNAC stands for - what
I wanted to know was what this particular report meant - in
particular, the "high degree of cellularity"+"dense population
of ductal epithelial cells"+"stromal fragments"+"few cells with
mild nuclear atypia" - what do these mean singly, and in
combination ?

Any elucidation of these will be greatly appreciated!

Thanks yet again.

[CCF-RN,MSN-rf]

Dear pintoo:
a) I assume this means fine needle aspiration cytology
b) This is a negative biopsy - it is not predictive of other possible problems.
c) The most common cancers in the breast are Ductal carcinomas.  (the difference between DCIS and invasive ductal cancer is whether the cells penetrate (invade) the duct walls.  Lobular cancer is less common.  Once cannot tell what possible problems could be.
d) According to this biopsy, and this pathologist, this sample is most consistent with fibroadenoma.  Another pathologist might agree or disagree with this finding.
e) If the recommendation was to do an excisional biopsy, then this was the right choice.  Depending on the result, one could argue, after the fact, of course, whether this was too aggressive or not.  If there was any doubt before, then it was the right choice.
f) If there is no cancer, then the nodes do not need to be checked.  
Finally, a biopsy is more definitive than an ultrasound with regard to diagnostic testing.