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International Journal of Surgical Pathology
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The Role of Cytokeratin 5/6 as an Adjunct Diagnostic Tool in Breast Core Needle Biopsies

Sharon Nofech-Mozes, MD

Department of Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada

Claire Holloway, MD, PhD, FRCSC

Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada

Wedad Hanna, MD, FRCPC

Department of Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada, wedad.hanna{at}sunnybrook.ca

In this article, the probability of finding malignancy on surgical excision after applying well-defined morphological criteria combined with immunohistochemical evaluation of cytokeratin 5/6 for the diagnosis of atypical ductal hyperplasia on core biopsies is examined. On the basis of morphology alone, the reviewers reclassified the diagnoses of 140 core biopsies as follows: atypical ductal hyperplasia (n = 64), ductal hyperplasia of usual type (n = 44), flat epithelial atypia (n = 11), and miscellaneous benign (n = 21). Cytokeratin 5/6 immunostain was negative in 85.7% of atypical ductal hyperplasia cases and positive in 77.8% of ductal hyperplasia of usual type cases. The probability of predicting malignancy in a surgical specimen following a core biopsy increased from 43.6% to 67.8% (P = .002) by adhering to defined criteria and using cytokeratin 5/6 immunostain. Expertise and adherence to defined criteria are required to establish an accurate diagnosis of atypical ductal hyperplasia. Cytokeratin 5/6 can be a useful adjunct in cases with ductal hyperplasia but not in columnar cell lesions, where it is universally negative.

Key Words: ADH • UDH • columnar cell lesions • flat epithelial atypia • cytokeratin 5/6 • breast cancer • core needle biopsy

This version was published on October 1, 2008

International Journal of Surgical Pathology, Vol. 16, No. 4, 399-406 (2008)
DOI: 10.1177/1066896908316901
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