Diagnostic Accuracy and Clinical Utility of Fine-Needle Aspiration in Breast Lesions: A Correlation with Surgical Pathology

Abstract

Background: Fine-needle aspiration (FNA) is a valuable diagnostic tool for evaluating breast lesions, yet its use is less frequent compared to core needle biopsies. This study aims to assess the diagnostic performance and clinical utility of FNA in correlation with surgical pathology outcomes. Methods: We performed a three-year retrospective search using our institutional database to identify cases of breast mass FNAs performed by interventional radiologists under ultrasound guidance. We reviewed cytopathology reports and glass slides, and correlated cytologic diagnoses with concurrent or subsequent surgical pathology results. Results: A total of 65 breast FNA cases from --- patients were reviewed. The diagnostic outcomes were: 23% insufficient for diagnosis, 11% atypical, 8% suspicious for malignancy, 3% positive for malignancy, and 55% negative for malignancy. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FNA for detecting malignancy were 76%, 96%, 93%, and 85%, respectively. One false positive case, categorized as atypical due to degenerative changes, was later confirmed as benign apocrine metaplasia. Three false negative cases, initially categorized as non-diagnostic, were later diagnosed as invasive ductal carcinoma, Hodgkin lymphoma, and papillary carcinoma. An additional false negative case, categorized under negative for malignancy, was later diagnosed as invasive ductal carcinoma. Conclusion: Breast FNAs, while less frequently performed than core needle biopsies, provide significant diagnostic insights, particularly for cystic lesions. The study demonstrates high specificity and PPV for FNA in detecting malignancy, underscoring its value as a diagnostic tool when integrated with imaging and clinical assessment. These findings support the continued use of FNA in the diagnostic evaluation of breast lesions.