Is there still a role for fine-needle aspiration cytology in breast cancer screening?

Abstract

In mammography screening, the majority of abnormalities are the result of nonmalignant proliferative breast lesions.1,2 Preoperative diagnostic procedures are adopted in the investigation of suspicious or equivocal screen-detected breast lesions to avoid unnecessary open biopsy. The high-quality performance of a nonoperative procedure provides the best benign-to-malignant ratio in open biopsy. The quality assurance system is an integrated part of breast screening programs 3 and is necessary to evaluate screening performance.Fine-needle aspiration cytology (FNAC) has been used extensively over the years in the diagnosis of breast lesions. However, despite the many benefits (eg, fast turnaround time, patient compliance, and its reputation as a simple and cost-effective method), it has been increasingly criticized of having a high inadequate rate (IR) and suboptimal accuracy. [4][5][6] The preoperative confirmation of breast cancer by FNAC has gradually been reduced in many screening programs in which the results were not satisfactory and replaced by microhistology, consisting of ultrasound-guided core needle biopsy (USCNB) or stereotactic core needle biopsy (SCNB). 4,[7][8][9] The IR for FNAC is inversely proportional to the operator's level of experience and the presence of specialized cytologists.10-13 Radiologic imaging 5,6 and the type of guidance system used are additional factors that could affect the performance of FNAC.5 Diagnostic accuracy can be achieved through a multidisciplinary consultation, combining FNAC results with clinical and radiologic data (the triple test).14 The diagnostic value of FNAC improves with the immediate onsite evaluation of specimens. 10,15 Immediate cytologic diagnosis in real time is cost-effective and allows those patients with benign diseases to be given immediate reassurance whereas the management of patients with malignant or suspicious lesions can be quickly planned. 16,17 The current study describes the quality performance results of FNAC over a 5-year period of activity at the Breast Cancer Screening Program in Verona (BCSPV ), in which the integrated radiopathologic, real-time assessment of suspicious lesions and immediate cytologic reports are performed. The objective of the current study was to highlight FNAC accuracy when it is part of an integrated radiopathologic service in which the cytologic sample results are immediately matched with clinical and imaging findings.

Liquid-Based Cytology of the Breast: Pitfalls Unrecognized before Specific Liquid-Based Cytology Training - Proposal for a Modification of the Diagnostic Criteria

“…Efficiency of breast FNAC, however, also depends on the skill and on the experience of the individuals performing sampling [2,9,19]. LBC reduces air-drying, spreading artifacts and the obscuring effects of blood and inflammation.…”

“…In conclusion, while FNAC of the breast with CSm is a very efficient and rapid method [2], LBC constitutes a promising tool because it reduces the artifacts. It also permits the preparation of additional samples [24], facilitating the application of special techniques such as immunohistochemistry and molecular biology [25,26].…”

“…Fine needle aspiration cytology (FNAC) of the breast is an effective method of diagnosing breast cancer [1,2]. Conventional alcohol-fixed Papanicolaou-stained smears (CSm) are efficient and cost-effective.…”

International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology: A Review of Predictive Values and Risks of Malignancy

“…[47] utilized a probabilistic approach in breast FNAB in their retrospective study of 1,995 cases with a ROM of 78% for suspicious and the FNAB suspicious cases, which were benign on surgical follow-up, including mucocele-like lesions, nipple adenoma, adenosis tumor, ductal hyperplasia, and fibroadenomas. While several recent studies discussed here combine atypical and suspicious breast FNAB categories as Indeterminate or similar designation, it has been shown previously that ROM is higher in the suspicious cases, and a distinct atypical category should be differentiated from the suspicious of malignancy category [48, 49]. …”

Breast Cytology - Undetermined Diagnoses and Unsatisfactory Samples

“…Breast cytology is a very efficient diagnostic method especially in integrated teams, where there is close on-site collaboration between radiologists and pathologists [2]. However, breast cytology has been criticized because of the elevated number of C1/unsatisfactory samples and of uncertain (C3/atypical and C4/suspicious) categorizations [3] that generate anxiety and expose patients to the risk of overtreatment.…”