Fine-needle aspiration and cytologic findings of surgical scar lesions in women with breast cancer

Abstract

Benign and/or malignant lesions may occur in surgical scars after mastectomy or lumpectomy (SML) in patients with breast cancer (BC). Early diagnosis of these lesions is essential for both therapeutic and prognostic evaluation. The diagnostic value of fine‐needle aspiration (FNA) was determined for these scar lesions. The findings of cytologic and histologic specimens obtained from the same lesion of SML in 83 women with BC were correlated. Twenty‐five FNA yielded only acellular specimens. Of the FNA done by the cytopathologist, only 6.2% were not representative. However, 45% of those done by less experienced clinicians were not representative. Representative FNA were obtained from 58 of the women who took part in the study. Based on the histologic diagnosis, 38 patients had malignant scar lesions (MSL), and 20 had benign scar lesions (BSL). In one patient of the 38 with MSL, cytologic examination did not show the malignant lesion; in four women, the tumor was suspected cytologically; and in the remaining 33, the cytologic findings were consistent with malignancy. In 18 of the 20 patients with BSL, cytologic findings were reported as benign and in the other two, as inconclusive. The sensitivity, specificity, and positive and negative predictive values for the cytologic findings were 97.4%, 100%, 100%, and 94.7%, respectively. The diagnostic accuracy of FNA cytology was 98.2%. No complications followed the procedure. It was concluded that FNA cytologic examination of lesions in SML is a simple, safe, highly accurate, and cost‐effective method to distinguish malignant from benign lesions in women with BC. Lesions in SML should be explored routinely by FNA, rather than by the traditional biopsy, provided the FNA is done by an experienced operator.

Core Biopsy as Alternative to Fine‐Needle Aspiration Biopsy in Diagnosis of Breast Tumors

“…Ciatto [12] has demonstrated that FNA can bypass the use of frozen sections in 70% of cancer cases, whereas in our series, intraoperative biopsy was avoided in 88% of cases, including those cases which presented difficulties with the core biopsy procedure because of the well-known technical limits. In agreement with other authors [14,31], our experience has also demonstrated the importance of the physician in this technique; in fact, the surgeon who performed the clinical and bioptic procedures was always the same (FS).…”

Fine-needle aspiration cytodiagnosis of recurrent carcinoma of the breast in operative scars

“…Therefore, such a first line of investigation in the evaluation of the accessible, palpable, and generally superficial scar lesions of the breast is very desirable. 1,2 Our results in aspirates are in full agreement with these studies, 1,2 with the high incidence of diagnosis of recurrent scar malignancy in 104 of the FNAC samples and an exclusion of recurrent tumour in 52 samples. Also, the…”

“…In the past, some clinical studies have indicated that local recurrence of breast carcinoma can occur in 10 to 40% of cases and is associated with a gloomy outcome despite management. 1,[3][4][5][6][7][8] However, the results of a more recent clinical study 9 indicates that such a pessimistic attitude is unwarranted. The same study 9 also indicates that cases of breast carcinoma which have been surgically treated must have a close follow-up; any suspicious nodule which appears must be recognised early and subjected to a tissue diagnosis so that a prompt therapeutic decision can be made to obtain best results.…”

“…Local recurrence of breast carcinoma in surgical scars is not uncommon, and it is claimed that 10-40% of patients may show a recurrence. 1 A timely diagnosis of carcinoma in scars is important for appropriate therapeutic decisions, so as to enable a better quality of life in patients. Traditionally, the differentiation between benign and malignant scar lesions has been done by the invasive means of surgical biopsy and histologic examination of the excised tissue.…”

“…In recent years, the role of fine-needle aspiration cytology (FNAC) has had an impact in the diagnosis of a variety of lesions; its use as a first line of investigation in the diagnosis of recurrent breast carcinoma in operative scars has been suggested in a few recent studies. 1,2 In this communication, we present our experience with FNAC of scar lesions in patients which had been surgically treated for breast carcinoma over a period of 12 1 ⁄2 yr.…”