SIGNIFICANCE OF SILVER STAINING OF NULCEAR ORGANIZER REGIONS IN FINE NEEDLE ASPIRATION SMEARS OF BREAST LESIONS

Abstract

Background: Demonstration of Nucleolar Organizer Regions (NORs) by silver impregnation method can differentiate malignant lesions from benign, reactive and inflammatory breast lesions. As the technique is based on mitotic activity, it is also useful in prediction of clinical behavior of diagnosed lesion. Most importantly, it is able to pick up grey zone lesions between benign and malignant.

Objective: To establish AgNOR staining as a diagnostic and prognostic tool in the management of various breast lesions including precancerous lesions.

Method: In the present study, AgNOR silver staining impregnation method was applied on air dried smear of breast FNAC along with routine H & E stain.

Results: Out of total 79 (87.77%) satisfactory smears of breast FNA, 52 (65.8%) benign cases showed mean AgNOR count (mAgNOR) 3.45 + 1.19, proliferation index (pAgNOR) 20.47 + 14.8 and AgNOR score of 9.25± 3.30 and 24 (38.3%) malignant cases showed mAgNOR 9.54 ± 2.53; pAgNOR 65.12 ± 15.12; AgNOR score 26.56±6.98. the difference between AgNOR counts of benign and malignant lesions was statistically highly significant.(p value is <.001).

Conclusions: AgNORs study in fine needle aspiration was found to be simple, feasible and very effective technique. AgNOR counts help to discriminate benign lesions from malignant lesions and other features like size, shape and distribution of the AgNOR dots help to judge aggressiveness of the malignant tumor.