Fine-Needle Aspiration in Suspected Inflammatory Breast Cancer: Case Series with Emphasis on Approach to Specimen Adequacy

Abstract

Objectives: To highlight the utility of a tangential approach in the fine-needle aspiration (FNA) technique for obtaining cellular material adequate for a conclusive diagnosis in diffusely enlarged breast without a discrete lump. Study Design: FNA was performed on 5 women clinically suspected to have inflammatory breast cancer (IBC). All had unilateral diffusely enlarged breasts with peau d’orange changes of the skin. No distinct lump was palpable. The procedure was performed using a 10 cm³ syringe with a tangential approach of a 23-gauge needle in all 4 quadrants with extra passes in the antigravity areas. Rapid on-site evaluation for adequacy was done. Results: All women were of African descent within the age range of 34–57 years. One case had a recent history of lactation. FNA smears showed low-to-moderate cellularity. One case was suspicious and 4 were positive for ductal carcinoma. Core biopsy confirmed IBC in 3 cases. Two cases had a mastectomy; 1 of these cases had preoperative neoadjuvant chemotherapy. Conclusion: The approach of FNA used in these cases helped to establish the diagnosis of IBC in 4 women presenting with a diffusely enlarged and tender breast, resulting in the timely initiation of appropriate management. The technique needs to be assessed in a larger cohort of women with diffusely enlarged breast to evaluate its diagnostic utility.

Concordance of breast fine needle aspiration cytology interpretation with subsequent surgical pathology: An 18‐year review from a single sub‐Saharan African institution

“…In Kenya, where breast cancer is the most prevalent malignancy afflicting females, the vast majority of patients present with locally advanced disease detectable by palpation at physical examination . Little is published on the utility of FNAC for palpable breast lesions in Kenya, a low income country that lacks routine screening programmes and universal access to healthcare . We set out to retrospectively examine the African Inland Church (AIC) Kijabe Hospital experience with breast FNAC over an 18‐year 9‐month period of clinical practice serving as the primary referral centre for four smaller AIC hospitals and over 50 rural clinics…”

Confocal fluorescence microscopy for rapid evaluation of invasive tumor cellularity of inflammatory breast carcinoma core needle biopsies

“…The presence of lymphovascular tumor emboli in the skin biopsy and invasive mammary carcinoma in the core biopsy can establish the diagnosis and initiate the clinical management of the patients. Tissue sampling can be a particularly problematic issue in IBC, since most cases present with no discrete mass and therefore accurate targeting of the area of breast for image-guided CNBs can be difficult [ 5 , 6 ]. Shah and colleagues showed that sampling error can lead to inadequate CNB specimens, which have an insufficient amount of tissue to make a diagnosis, in as many as 9.1 % of cases [ 7 ].…”