Critical appraisal of cytological nuclear grading in carcinoma of the breast and its correlation with ER/PR expression

Background: Cytological nuclear grading is one of the several key prognostic factors that should be addressed in cytological analysis of breast carcinomas. Aims: To evaluate different cytological nuclear grading methods on fine needle aspirates of breast carcinomas and its correlation with histopathological nuclear grading as well as with the immunocytochemical expression of estrogen receptor (ER) and progesterone receptor (PR). Materials and Methods: The smears from 30 cytologically proven cases of breast carcinoma were graded by - Nottingham′s modification of Scarff Bloom Richardson, Fisher′s modification of Black′s nuclear grading and Robinson′s cytological grading methods. 18 cases were available for correlation with histology grading. Results: Robbinson′s cytological grading system was found to have the best correlation with histopathology grades (P < 0.001) as well as ER (P = 0.003) and PR (P = 0.001) expression on smears. Conclusions: The Richardson′s cytology grading method is recommended for cytological nuclear grading along with ER / PR expression, without which the cytological diagnosis of breast carcinoma is incomplete.