The value of AgNOR in detection of breast malignant cells in FNA samples

Abstract

Background Breast cancer is prevalent and common globally. This study aimed to determine the value of Argyrophilic Nucleolar Organizer Regions (AgNORs) in detection of breast malignant cells among Sudanese women. This laboratory based study was carried out in Khartoum state (Sudan), among Sudanese women who presented with breast lumps in governmental and private cytology clinics in Khartoum city. FNA samples were collected from each patient. Wet fixed smears were stained Pap staining techniques, while air-dried smears stained with AgNOR. Nucleolar Organizer Regions (NORs) are segments of DNA, closely associated with nucleoli containing coding gene for Ribosomal RNA and contribute to the regulation of the cellular synthesis. Recent modification of a silver staining technique allows NORs to be visualized in conventional histopathological sections where they are called as “ArgyrophilicNucleolar Organizer Regions (Ag NORs)”. For the evaluation, the numeric results (The mean and standard deviation (mAgNOR ± SD) of AgNOR dots in 100 tumor nuclei and the Proliferative Index (pAgNOR), the percentage of cells having 5 or more AgNOR dots per nucleus in 100 nuclei). Pearson correlation coefficient (p-value) and ANOVA tests were used through the Statistical Package for Social Sciences (IBM SPSS Statistics 21) to compare the values observed in each cytological category and the values observed for counting 100 tumor nuclei. Results The mean values and SD of AgNOR (mAgNOR) and proliferative Index (pAgNOR) were 3.66 ± 2.8 and 2.22 ± 2.1, respectively. On the other hand, ANOVA test showed a significant increase in the mean values of the malignant findings in both parameters. The correlation between cytological changes categories and the means of AgNOR (mAgNOR) showed a statistically significant test (P = 0.001). Additionally, the correlation between cytological assessment categories and the means of proliferative index (pAgNOR) showed a statistically significant result. Conclusions The estimated breast cellular proliferative activity by means of AgNORs per nucleus quantification and cytological atypia improves the accuracy of FNA in comparison with standard Pap stains. AgNORs is a valuable technique in the detection of breast malignant cells among Sudanese women.