Liquid-Based Cytology in Fine-Needle Aspiration of Breast Lesions: A Review

Abstract

Objective: Fine-needle aspiration (FNA) is a safe and cost-effective technique for the diagnosis of breast lesions, especially when correlated with clinical and imaging studies. However, the success of breast FNA is highly dependent on the adequate preparation of cytological conventional smears (CS). The liquid-based cytology (LBC) technique consists of an automated method for preparing thin-layer cytological samples from cell suspensions collected in alcohol-based preservative. LBC is designed to improve CS by avoiding limiting factors such as obscuring material, air-drying and smearing artifacts. Study Design: We performed a review of the published literature about LBC applied to breast FNA. Results: LBC preparations of breast aspirates demonstrated better cellular preservation, less cell overlapping and elimination of blood and excessive inflammation compared to CS. Conversely, alterations in architecture and cell morphology as well as loss of myoepithelial cells and stromal elements have been described in LBC specimens, requiring training before applying this technique for diagnosis. Studies have shown a similar accuracy between LBC and CS for the diagnosis of breast lesions. LBC also permits the use of residual material for ancillary tests, which is an important advantage compared to CS. Conclusions: LBC can be safely applied to breast FNA, showing a similar diagnostic accuracy to CS.

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

“…A cytopathologist performing and then interpreting the smears is at a great advantage to reach an accurate diagnosis [16, 25-27]. Liquid-based cytology has been utilized quite successfully but is more costly and many key diagnostic cytological findings are lost [28]. …”

Cytomorphological Study of Palpable Breast Lumps: Spectrum of Lesions and Diagnostic Utility of FNAC

“…[6] The sensitivity and specificity of FNAC as a diagnostic tool for palpable breast lumps are 65-99% and 96-100% respectively. [7] Usually when the size of the breast lump exceeds 2.0 cm it becomes clinically palpable. With increase in age of patient the tendency of being malignant of breast lumps increases.…”

Manual Liquid Based Cytology in Breast Fine Needle Aspiration – Comparison with the Conventional Smear

“…Perez-Reyes et al 19 employed split sampling technique where they divided the aspirate into two halves, one for LBC and the other for CS, hence in their study the cellularity of LBC was inferior to CS. Gerhard R et al 22 observed that the number of passes performed and the skills of the person performing the procedure determine the quality and cellularity of the samples.…”