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

Abstract

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 ...

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

“…The high IR of FNAC samples in this setting has made its use impractical and has encouraged the use of CNB in breast screening programs. 4,[7][8][9] FNAC performance in the BCSPV is only marginally affected by the radiologic imaging of the lesions (Table 4). The absolute IR is higher in lesions with calcifications, particularly calcification clusters (IR of 19.4%), than in mass lesions (Table 4), with a statistically significant difference noted (P \.0001) (Table 5).…”

“…[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][11][12][13] Radiologic imaging 5,6 and the type of guidance system used are additional factors that could affect the performance of FNAC.…”

“…[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.…”

A Comparative Evaluation of Fine Needle Aspiration Cytology, Trucut Needle Biopsy & Imprint Cytology and Histopathology in Breast lumps

“…In this study TCNB is positive in 87.5% benign lesions and 100% in malignant lesions. [6][7][8][9] IC is also a safe one with high accuracy for malignant cases for which excision or /incision biopsies are avoided and definite surgery done .In this study IC report positive in 84.8% benign cases and 100% in malignant cases. [10][11][12] All …”

The Accuracy of Fine Needle Aspiration on Superficial Palpable Body Masses in Patients at Tikrit City

“…a malignant neoplasm was higher for FNA than for core biopsy (97% vs. 90%) i.e., the false negative is higher in core biopsy than FNA and the addition of core biopsy fail to increase the sensitivity in carcinoma detection. This is owing to the ability of FNA to sample a larger area by numerous multidirectional passes of the needle this is increase the probability of successful sampling especially in small lesions and the maintenance of a tactile sensitivity [16]. Sun et al [17] conclude that if FNA is performed by pathologists were more sensitive than core biopsy, this related to the immediate examination for cellularity and quality and additional aspiration of the tumor if inadequate initial specimen.…”