Fine needle aspiration cytology as an adjunct to core biopsy in the assessment of symptomatic breast carcinoma

Pilgrim, Simon; Ravichandran, D.

doi:10.1016/j.breast.2004.11.001

Cited by 24 publications

(29 citation statements)

References 14 publications

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“…When both tests were performed under ultrasound guidance, some found the sensitivity of the FNAC to be equal to that of CB (Hatada et al, 2000;Westenend et al, 2001), whereas others showed CB to be better (Chuo and Corder, 2003). In 112 breast cancers from our symptomatic unit, FNAC did not provide useful additional information owing to CB correctly diagnosing nearly all cancers leaving little room for FNAC to improve upon the preoperative diagnosis rate (Pilgrim and Ravichandran, 2005). Fewer comparison studies of similar nature have been reported with screen-detected breast cancers.…”

Section: Discussionmentioning

confidence: 83%

Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma

2006

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Core biopsy (CB) has now largely replaced fine-needle aspiration cytology (FNAC) in the preoperative assessment of breast cancer in the UK. We studied the contribution of FNAC and CB in the preoperative diagnosis of screen-detected breast carcinoma. Data were prospectively collected on 150 840 women who underwent breast screening over a 4-year period from 1999 to 2003. Data on women who had both FNAC and CB taken from the same lesion preoperatively and in whom surgical excision of the lesion subsequently confirmed malignancy was analysed. In 763 cancers, FNAC was inadequate (C1) in 8% and benign (C2) in 10%. Most of these cases presented with microcalcification (25% were C1 or C2). Core biopsy was not representative (B1) or benign (B2) in 7%. The absolute and complete sensitivities were 65 and 82% for FNAC and 80 and 93% for CB in the diagnosis of cancer. Core biopsy was abnormal (B3 or above) in 86% of the cancers missed by FNAC and FNAC was abnormal (C3 or above) in 65% of those missed by CB. Core biopsy is better than FNAC at preoperative diagnosis of screen-detected breast cancer as it missed fewer cancers. However, combining FNAC resulted in a better preoperative diagnosis rate. The National Health Service Breast Screening Programme (NHSBSP) was introduced in the United Kingdom in 1987, following publication of the findings of an expert committee the previous year. At present, all women aged 50 -70 years are offered two-view screening mammography every 3 years. Patients with radiologically suspicious lesions are recalled for further assessment that may include clinical examination, special mammographic views, ultrasound and collection of tissue for pathological assessment by fine-needle aspiration cytology (FNAC), core biopsy (CB), or more recently, by wide bore vacuum biopsy.In the early stages of NHSBSP, FNAC was the test used in the assessment. Core biopsy was introduced in the assessment process in late 1990s. The experience with this technique has improved considerably and CB is now considered to be the standard. The preoperative diagnosis rate of screen-detected carcinoma has been improving with increasing use of CB. Correspondingly, the use of FNAC is in decline and a number of screening units in the UK have abandoned it completely (Britton et al, 1997).At the Bedfordshire and Hertfordshire Breast Screening Unit, CB was introduced in the assessment of screen-detected breast lesions in 1997, but we continued to perform FNAC in addition in the majority of patients with suspicious lesions. The aim of this study was to assess the performance of FNAC and CB in the preoperative diagnosis of screen-detected breast carcinoma. MATERIALS AND METHODSData were prospectively collected on all women who attended the Bedfordshire and Hertfordshire Breast Screening Unit, England. We reviewed a 4-year period from April 1999 to March 2003. This period was chosen to ensure that operators had gained sufficient expertise in the use of CB, which was introduced in 1997. We selected, for detailed analysis, the women who had ...

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Section: Discussionmentioning

confidence: 83%

Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma

2006

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“…8 Our experience confirms that FNAC can be a sensitive and an effective method of diagnosis of breast cancer. 2,3,4,28 CB has been increasingly adopted in many centers because it allows more accurate categorization of both benign and malignant diagnoses and because it reduces the number of inadequate samples. 4,6,[31][32][33] In addition, CB allows immunohistochemical studies and separates in situ from invasive carcinomas.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] CB, however, is more sensitive than FNAC in making unequivocal diagnoses. 1 The results of both FNAC and CB depend on the skill and experience of the individuals performing sampling, laboratory technical procedures and microscopic interpretation.…”

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confidence: 99%

Fine Needle Aspiration Cytology of the Breast

Feoli

Paesmans²,

Eeckhout³

2008

Acta Cytologica

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“…Table 4 summarizes the advantages of the combined procedure. Therefore, and as shown by other investigators, the utilization of both aspirate smears and core tissue biopsy material are complementary and have added value compared to either one alone [7,13,26,29,33,35,38,39,44,45,46,47,50,51,52,57,58,59,60,61,62,68,75,76,77,78]. …”

Section: Advantages Of the Combined Approachmentioning

confidence: 86%

“…Moreover, FNAB alone cannot confirm the presence of tumor invasion and cannot be used to differentiate between invasive and in situ neoplasia [29,30,31]. In addition, low-grade breast lesions, such as atypical ductal hyperplasia, low-grade ductal carcinoma in situ and tubular carcinoma, cannot be accurately diagnosed using this modality alone [32,33,34,35]. …”

Section: Limitations Of Fnabmentioning

confidence: 99%

Fine-Needle Aspiration Followed by Core-Needle Biopsy in the Same Setting: Modifying Our Approach

Joudeh¹,

Shareef²,

Al‐Abbadi³

2016

Acta Cytologica

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Fine-needle aspiration biopsy (FNAB) is a well-established initial diagnostic tool. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis. Consequently, patients have to undergo another diagnostic procedure. The second procedure is either repeat FNAB, core-needle or open biopsy, and can be inconvenient and costly. In some centers, the FNAB is immediately followed by core-needle biopsy (CNB) in the same setting after assuring adequacy on the initial FNAB utilizing rapid on-site specimen evaluation (ROSE). It is argued that implementing such an approach will eventually have additional critical advantages that include the following: (a) it is more convenient to patients to have both procedures in one visit, (b) the tissue procured by both procedures will be more adequate, enabling cytopathologists to reach an accurate diagnosis, and (c) it is ultimately a cost-effective approach if we take into consideration the avoidance of a potential second more invasive diagnostic procedure. Since we are living in an era of patient-centered medicine coupled with cost-cutting strategies, we present here a brief review of the topic with analysis of this alternative approach, review of the pertinent literature and shed light on a few scenarios that justify this approach.

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Fine needle aspiration cytology as an adjunct to core biopsy in the assessment of symptomatic breast carcinoma

Cited by 24 publications

References 14 publications

Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma

Role of fine-needle aspiration cytology and core biopsy in the preoperative diagnosis of screen-detected breast carcinoma

Fine Needle Aspiration Cytology of the Breast

Fine-Needle Aspiration Followed by Core-Needle Biopsy in the Same Setting: Modifying Our Approach

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