Breast fine needle aspiration continues to be relevant in a large academic medical center: experience from Massachusetts General Hospital

Abstract

Fine needle aspiration (FNA) is increasingly being supplanted by core needle biopsy. However, breast surgeons continue to rely on FNA at our institution. This retrospective study evaluated breast FNA for its diagnostic accuracy and breast cancer biomarker testing utility. All breast FNAs performed at Massachusetts General Hospital 2009-2015 were reviewed. Cytology diagnoses were compared with subsequent tissue or clinical diagnoses. Immunohistochemistry and fluorescence in situ hybridization (FISH) results using formalin-fixed paraffin-embedded (FFPE) cell blocks and histologic tissue blocks were compared. 1654 consecutive breast FNAs were included. Breast FNA demonstrated the following diagnostic performance: positive predictive value of malignant cytology diagnosis 100 %, negative predictive value of benign cytology diagnosis 97.5 %, complete sensitivity 91.6 %, and specificity 95.5 %. Concordance rates for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) immunohistochemistry, and HER2 FISH were 98.2 % (κ = 0.95, p < 0.001), 100.0 % (κ = 1.000, p < 0.001), 83.1 % (κ = 0.69, p < 0.001), and 93.5 % (κ = 0.785, p < 0.001), respectively. Review of consecutive breast FNAs in a large cohort confirmed the excellent accuracy of this biopsy technique for breast lesion diagnosis. FNA FFPE cell blocks collected in the course of routine clinical care are adequate, practical, and reliable for breast cancer biomarker testing.

The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

“…These variations include the varying mix of patients, the experience of the FNAB operators, the type of practice (mammographic screening assessment clinic or clinic for patients with symptomatic lumps and other concerns) and types of lesions (palpable or impalpable), and it is not unexpected that insufficient rates also vary from 0.7 to 47% [10, 12, 14-17]. Similarly, an accurate ROM cannot be established because insufficient cases are usually excluded from PPV and NPV analyses, because only patients with surgical biopsy follow-up are included in these studies and the indication for surgery was often clinical or radiological suspicion of carcinoma [15, 17, 34].…”

“…The definition and use of the term “suspicious of malignancy” varies in similar fashion to the term “atypical” and this is reflected in the published range of PPV of a suspicious diagnosis from 60 to 95% [3-6, 8, 12, 14, 15, 70-78]. Two recent studies utilizing the IAC Yokohama System had ROM for a “suspicious of malignancy” diagnosis of 97.1 and 84.6% [16, 17].…”

“…The PPV of a malignant breast FNAB ideally should be 100%, but there is a reported range from 92 to 100% [3-6, 8, 12, 14, 15, 70-78]. Two recent studies utilizing the IAC Yokohama Reporting System had ROM of 100 and 99.0% for the malignant category [16, 17].…”

“…The ancillary studies include immunocytochemistry, immunohistochemistry and molecular techniques. These ancillary techniques are of value in specific situations that include: diagnostic difficulties, for example, utilizing myoepithelial cell markers on cell block material in atypical and suspicious lesions; immunohistochemistry on cell blocks for the prognostic and predictive markers for estrogen, progesterone and HER2 receptors; in situ hybridization for HER2 on cell blocks; immunohistochemistry for the determination of a primary site in metastatic lesions; and the study of prognostic and predictive markers in the metastatic breast cancer setting [12, 25, 93]. …”

“…Routine rinsing of the needle or separate passes for cell block preparation to enable immunohistochemistry for prognostic indicators can be utilized [12, 29]. Liquid-based cytology preparations can also be considered [28].…”