The value of fine needle aspiration biopsy in the diagnosis and prognostic assessment of palpable breast lesions

Abstract

In recent years there appears to be a growing movement toward the use of core needle biopsy (CNB) over fine needle aspiration biopsy (FNAB) for the detection of breast carcinoma. This tendency is caused in part by the idea that CNB can provide a more specific or definitive diagnosis as well as the belief that the assessment of prognostic/predictive factor is not possible or reliable on cytologic specimens. At our institution, FNAB of breast has been practiced for over 25 years with excellent cytologic-histological correlation. This practice has been beneficial not only for patients, but also for training physicians since nowadays a very small number of centers in the United States still routinely perform fine needle aspiration as a diagnostic tool in breast cases. To assess the diagnostic accuracy of FNAB in palpable breast lesions, we reviewed our experience during an 8-year-period and compared fine needle aspiration results with follow-up surgical specimens. From the cytology point of view, the lesions were divided as negative/benign, atypical/suspicious, positive, and insufficient. Only cases performed by pathologists were included. A total of 1,583 cases were retrieved from our archives. A definitive malignant diagnosis was reached in 357 cases. One-hundred and thirty-nine cases were classified as atypical/ suspicious, 135 cases had insufficient cells for establishing a diagnosis, and 952 were categorized as negative. A total of 408 follow-up surgical specimens were available for comparison with cytologic results. There were 19 false-negative, and no false-positive results were found. The majority of false-negative results were secondary to sampling errors. In 93% of the malignant cases, there was enough material obtained in cytological specimens to perform prognostic/predictive factors studies. Our data proves once again that FNAB is a reliable method for the initial evaluation and diagnosis of palpable masses of the breast. In addition, it also has the ability of providing necessary prognostic/predictive information, particularly for patients that may undergo neoadjuvant therapy.

Fine Needle Aspiration Cytology of Palpable Breast Lump: A Study of 1778 Cases

“…Bukhari and Akhtar [21] and Bukhari et al [8] found 11.42 % and 8.4% suspicious cell for malignancy respectively. 139 (9%) cases were atypical/suspicious for malignancy reported by Rosa et al [22] and 51 (3.3%) atypical by Yeoh and Chan [23]. Cytologic atypia comprises nuclear pleomorphism, loss of cohesiveness, irregular nuclear contours, irregular chromatin pattern, hyperchromasia, and high nuclear/cytoplasmic ratio.…”

“…Bukhari et al [8] reported 20% inadequacy and reduced the number by repeating up to twice. Insufficient cases require re-evaluation of clinical and radiological findings as well as adequate follow-up, mostly in cases of palpable breast abnormalities [22].…”

Effectiveness of the Triple Test and Its Alternatives for Breast Mass Evaluation

“…Early diagnosis and treatment, besides being life-saving, reduces morbidity (1). Various examinations, interventions or their combinations are used for early diagnosis.…”

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.…”