The role of breast FNAC in diagnosis and clinical management: a survey of current practice

Abstract

The role of breast FNAC in diagnosis and clinical management: a survey of current practice Most participating countries have now adopted a triple assessment approach, i.e. clinical,imaging and pathology, to breast diagnosis, with FNAC as the first-line pathological investigation in both screening and symptomatic populations, with the exception of microcalcifications. Pathologists specialized in cytopathology are best qualified to collect and interpret FNAC samples, but this is not always possible or practical. Radiologists involved in breast imaging should ensure that they have the necessary skills to carry out FNAC under all forms of image guidance. Best results are achieved by a combination of both techniques, as shown in the image-guided FNAC in the presence of the cytopathologist. The majority of European countries use similar reporting systems for breast FNAC (C1-C5), in keeping with European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis, although some still prefer descriptive reporting only. When triple assessment is concordant, final treatment may proceed on the basis of FNAC, without a tissue biopsy. ER and PR assessment can be done safely on FNAC material. However, not all institutions may have expertise in doing this. HER-2 protein expression on direct cytological preparations is insufficiently reliable for clinical use, although its use for FISH is possible, if expertise is available. The majority of participants practise a degree of one-stop diagnosis with a cytopathologist present in the outpatient clinic. Formal recognition of the importance of the time spent outside the laboratory, both for cytopathologist and cytotechnologist, is necessary in order to ensure appropriate resourcing. The use of core biopsy (CB) has increased, although not always for evidence-based reasons. CB and FNAC are not mutually exclusive. FNAC should be used in diagnosis of benign, symptomatic lesions and CB in microcalcifications, suspicious FNAC findings and malignancies where radiology cannot guarantee stromal invasion. Keywords: breast cancer, breast diagnosis, breast management, breast cytology, FNA, core biopsy Fine needle aspiration cytology (FNAC) has been extensively used for many years in the diagnosis of breast lesions, but its use has gradually been reduced in many screening programmes because of its controversial inadequate rates and suboptimal accuracy in inexperienced hands. 1-3

Office management of a palpable breast lump with aspiration

“…17 A triple assessment (examination, imaging and aspiration) to diagnose solid breast lumps ensures concordance between the clinical findings and the results of imaging and pathologic examination. 18 Although some clinicians elect to monitor palpable, presumed fibroadenomas without cytopathologic testing, this approach will miss some breast cancers in young women. In this group, most delays in the diagnosis of breast cancer result from falsely reassuring clinical findings or imaging results.…”

Utility of Fine Needle Aspiration Cytology in the Evaluation of Breast Lesions

“…Fine Needle Aspiration Cytology (FNAC) is one of the important components of 'triple approach', which has been widely accepted for the preoperative diagnosis of breast lesions [1]. It is a multi-disciplinary approach that includes analysis of clinical and radiological findings in conjunction with FNAC features, to diagnose the breast lesions and to determine the best management plan for the patient.…”

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

“…Currently, breast FNA has a significant role in the evaluation of breast lumps however the success of breast FNA depends immensely upon correct preparation of cytological smears and skills of the person performing the procedure [13][14][15] which can ultimately lead to diagnostic failure. 16 Liquid based smears are better than the conventional cytological preparations since they avoid limiting factors such as obscuring material, airdried artifacts and irregular thickness of the smears.…”