Fine‐needle aspiration of breast lesions: Role and accuracy in a review of 7, 495 cases

Abstract

In the past 10 years, 7,495 cytological breast fine-needle aspirations (FNAs) were performed (4,756 FNAs of solid nodes and 2,739 of cystic nodes). Of these, 2,099 cases underwent surgery; 650 (31%) had histologically proven carcinoma. Sensitivity was 83.9%, specificity was 99.5%, the predictive value for negative results was 93.2% and for positive results was 98.6%, and the accuracy was 94.6%. Inadequate (13.3%) and doubtful samples (8.1%) were excluded from calculation. False-negative results (82 cases) mainly resulted from sampling errors. False suspicious results (six cases) lessened with increasing experience in breast pathology and with the application of strict diagnostic criteria, but most likely they will never reach zero. Frozen-section diagnosis could be bypassed only in selected cases. Guidelines on the role of FNA in management of solid breast lesions are given. FNA deserves further evaluation in diagnosing early stages of breast carcinoma: sensitivity was 7.5% in 57 carcinomas in situ, 67.5% in 55 minimally invasive carcinoma, and 92.7% in 538 nonminimally invasive carcinomas.

Critical clinicopathologic analysis of 23 cases of fine-needle breast sampling initially recorded as false-positive

“…Arisio et al22 reported 6954 fine‐needle aspirates with a false‐positive rate of 0.3%. Collective analysis shows that among experienced cytopathologists, the false‐positive rate varies between 0% and 0.86%, with an average rate of 0.17% 2, 9, 11, 22–27. This is close to the frequence observed in our series (0.25%) that, in addition, is comparable to the false‐positive rate reported on frozen sections 28–30…”

Usefulness of the Triple Test Score for Palpable Breast Masses

“…Mean patient age at time of evaluation was 49. 5 ing complaint for 84% of the women was a new breast mass; 13% presented with an abnormal mammogram, and a corresponding mass was found in these women by the clinician on breast examination. Breast pain was the chief complaint for 1.8% of the women, with nipple discharge (0.2%) and other various complaints (1%) comprising the rest.…”

Sclerosing papillary lesion of the breast: A diagnostic pitfall for malignancy in fine needle aspiration biopsy

“…16 Breast FNAB literature reported an incidence of false-positive or negative diagnoses ranging from 3 to 17%. 1,[17][18][19][20][21] Although these studies did not discuss the reasons for such erroneous diagnoses, inexperience of the cytopathologist with the cytologic features of some breast lesions was the main reason for incorrect diagnoses. 22,23 Utilizing FNAB in diagnosing the papillary lesions has been a focus of many studies with attempts to present reliable diagnostic criteria.…”