Core wash cytology of breast lesions by ultrasonographically guided core needle biopsy

Abstract

Previous studies demonstrated that core wash cytology by stereotactic needle biopsy was useful for the immediate diagnosis of breast lesions. The purpose of this study was to assess the accuracy of core wash cytology of breast lesions by ultrasonographically (US) guided core needle biopsy (CNB). US-guided 18-gauge CNB was performed in a series of 458 cases. Each CNB sample was washed in saline solution. Core wash cytology of the washed core material was performed on material obtained by saline solution lavage of the fragments using a cytocentrifuge. The cytological diagnoses were divided into five categories: benign, atypical/indeterminate, suspicious/probably malignant, malignant, and unsatisfactory, which then were compared with the CNB results. The cytological diagnoses of the 458 cases were as follows: 106 lesions (23.1%) were benign, 28 lesions (6.1%) were atypical/indeterminate, 42 lesions (9.2%) were suspicious/probably malignant, 88 lesions (19.2%) were malignant, and 194 lesions (42.4%) were unsatisfactory. The core wash cytology had a sensitivity of 89% (141 of 158), and a specificity of 72% (76 of 106). The CNB showed 143 of 194 unsatisfactory samples (74%) to be benign, three to be high-risk, and 48 (25%) to be malignant. Unsatisfactory samples were obtained from significantly more benign than malignant lesions. In conclusion, the high rate of insufficient samples for core wash cytology of breast lesions by US-guided CNB makes its use impractical in this setting. This technique is not useful for immediate diagnosis of breast lesions by US-guided CNB.

One-day core needle biopsy in a breast clinic: 4 years experience

“…CWC has been less extensively studied [12,20], but the study by Uematso et al reports a sensitivity of 89%, with a specificity of 72%. This study however showed an inconclusive rate of 42% [20].…”

Modified core wash cytology (CWC), an asset in the diagnostic work-up of breast lesions

“…The recent CWC study of Uematsu et al on 458 consecutive patients with breast lesions showed a sensitivity and specificity of 89 and 72%, respectively, while 42.2% of the samples were considered as inadequate [2]. Also in that study inadequate samples were more often obtained from benign breast lesions which is probably due to the nature of these lesions.…”

“…Unfortunately, the results described in the literature with such cytological diagnostic approaches are variable. In studies on CWC the sensitivity and specificity varied from 85% to 89% and 72% to 98%, respectively, while the inadequate rate varied from 7% to 42% [1,2]. Studies on TIC showed variable results as well [3][4][5][6][7][8][9][10].…”

Preoperative cytological and histological diagnosis of breast lesions: A critical review

“…Therefore, they concluded that CW is not useful for same-day diagnosis of breast lesions. [91] Contrarily, in a small prospective laboratory study using a modified CW procedure on 30 breast lesions only 1 specimen was found to be inadequate.…”

“…[90,91] In a prospective study of 236 benign and 210 malignant cases, Uematsu and Kasami found 42% of CW samples to be inadequate (C1). Therefore, they concluded that CW is not useful for same-day diagnosis of breast lesions.…”