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Cellular pathology(critical review of topical paper)

Critical Review The purpose of the study by Lui et al (2006) was to assess the diagnostic cytological features of metaplastic carcinoma of the breast and throw light on alternative and less invasive diagnostic options. The study was conducted by reviewing 17 cytological preparations of fine needle aspiration samples from histologically confirmed metaplastic carcinomas of breast, obtained from 6 different institutions and comparing them with the already present histopathological results. Considering the fact that the malignancy is a rare occurrence, the number of cases studied can be ascertained as ‘ sufficient’. Based on the cellularity and atypia, 3 categories of histopathology were formed and compared. There were differences in tumor categorization between histopathological studies and cytological studies and these differences in numbers made the researchers conclude that cytological identification of metaplastic carcinoma of breast is not a reliable method. The hypothesis is unclear and the paper lacks key words, coherent language, a crisp abstract , a good flow, subheadings and link to others’ work. There is no mention of confounding factors and how they were taken care of. The introduction could have been more educative. There is no mention of limitations of the study. The results of the study were presented in the form of chart. The cellularity of the FNAC numbers was described as low, moderate and severe. The cut off point of the number of cells which can be categorized into each one of these has not been described. Also, many specimens (as many as 10) have been categorized as having mixed components. These have been allocated a tumor- group only based on the type of cells seen and in many, the numbers of cells are actually even low to categorize to a cancer-type. In as many as 6 cases, the types of cells are actually suspicious. Keeping these limitations in mind, there arise many doubts whether the basis on which classification done is reliable. However, this study is a good attempt to explore a simple means of detecting this rare cancer and provides the patient with alternate option to surgery.
Word count- 340
References
Lui, P. C. W., Tse, G. M. K., Tan, P. H., et al. (2006). Fine-needle aspiration cytology of metaplastic carcinoma of the breast. J Clin Pathol., Retrieved on 27th Feb, 2009 from http://jcp. bmj. com/cgi/content/abstract/jcp. 2006. 039412v1

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