Fine Needle Aspiration Cytology of the Breast: The Nonmalignant Categories

Abstract

Currently, accurate diagnosis of breast lesions depends on a triple assessment approach comprising clinical, imaging and pathologic examinations. Fine needle aspiration cytology (FNAC) is widely adopted for the pathologic assessment because of its accurracy and ease of use. While much has been written about the atypical and maliganant categories of FNAC diagnosis, little covers the non-malignanat category which represents a sheer number in all FNAC cases. Moreover, any false-negative diagnosis of the non-malignant cases may lead to missed diagnosis of cancer. This paper aims to discuss the issues of smear adequacy, the cytologic features of benign breast lesions and the dilemma of a false-negative aspirate. Much has been suggested about the smear adequacy criterion, including quantifying epithelial clusters, whereas others advocate basing adequacy on qualitative quantum of using noncellular features of FNAC. Various benign lesions could be easily diagnosed at FNAC; however, they have cytologic features overlapped with malignant lesions. False negativity of FNAC does occur; this could be caused by either “true” false-negative cases attributed to suboptimal sampling technique, poor localization of the mass or nonpalpable lesions or “false” false-negative cases due to interpretational errors. Though false-positive cases are less commonly found, they will also be discussed briefly.

Cytomorphological Study of Spectrum of Breast Lesions and Determination of Efficacy of Fnac in the Diagnosis of Various Breast Lesions

“…[2,4,5,6,7,8,9] Proof of malignancy is the usual aim of such a procedure although it can be used for diagnosis of benign lesions as well as some inflammatory conditions. [5,7,8] The present study comprised of 529 aspirations performed on 512 patients. In 17 cases (3.2%), a second pass was needed, as the material was inadequate in the first instance.…”

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“…Accuracy rate which ranges from 95.8 % t 97.87% [2][3][4] ii. Sensitivity rate which ranges from 95% to 98.4% [5,6] iii. Specificity rate which ranges from 60% to 93% [5,6] Inspite of these, there are instances where the smear is reported as inadequate which ranges from 0.7% to 25.3%, and this is influenced by the nature of the lesion, the available technology, and the experience of the operator.…”

Cytopathology of Canine Mammary Gland Affections

“…The nuclear to cytoplasmic ratio is increased, nuclear chromatin is fine to lacy and the cells have tail of cytoplasm that appear to trail away from the nucleus in one or two directions. The added presence of large number of bipolar/naked nuclei in the background of the smear is the reliable cytological feature in favor of fibroadenoma [33].…”