Needle aspiration of the breast with immediate reporting of material.

Abstract

Summary and conclusionsNeedle aspiration with immediate cytological reporting has been practised in a breast clinic for one year. Patients benefit by receiving immediately the provisional diagnosis and, when indicated, appointments for metastatic surveys. Close co-operation between surgeon and cytologist has resulted in increased skill in aspiration, better preparation of samples, and greater accuracy in interpretation of reports.Since 5% of clinically benign lesions have proved malignant, even on immediate reporting, we would recommend cytological examination of all breast lumps. IntroductionIn a newly established breast clinic preliminary use of aspiration cytologyl-3 gave an unacceptably high incidence of false-negative reports and unsatisfactory preparations. These were apparently due to poor aspiration technique and faulty preparation of slides.4 Accordingly it was arranged that a cytologist should prepare slides at the clinic. Now, using the Diff Quik rapid staining method, a provisional report is given within five minutes of aspiration. If the preparation is found to be unsatisfactory aspiration is immediately repeated.Results obtained during the first year of this procedure have been analysed, with particular emphasis on finding reasons for false-negative and unsatisfactory reports. The value of aspiration cytology in patient management, the usefulness of which was recently questioned,5 has been assessed prospectively.

Improved Breast Cytology Results with Near Patient FNA Diagnosis

“…The results of the present study are comparable to those other series, 4,6,[12][13][14][15][16][17][18][19][20][21][22] in which specificity ranged from 44% to 90%, absolute sensitivity from 30% to 91% and complete sensitivity from 66% to 99%. Because most non-NPFD specimens were reported by general pathologists, the significantly improved specificity from discrete breast lumps with NPFD in the present series could be explained by improved FNA sample acquisition, improved cyto- logic reporting by the cytopathologist or both.…”

“…Whether this lower unsatisfactory rate was the result of the skill (better at performing FNA) or of the technique (repeating unsatisfactory FNAs to obtain sufficient material prior to issuing a report) of the cytopathologist performing NPFD could not be determined from our data. Breast FNA unsatisfactory rates are influenced by patient factors-age, 18 lesion size, 2,18,21 lesion palpability (discrete lump or thickening), 6,7,10,15,20,23 benign or malignant histology, 6,18,20 and histologic type 2,21,24 -and operator factors. 3,4,16,18,25,26 Palombini et al noted better results from series in which the cytopathologist who interpreted the smears also performed the FNA.…”

“…[2][3][4][5] Others have emphasized the advantages of a cytopathologist providing an immediate report in the breast clinic. [5][6][7][8] Few authors, however, have reported the combination of a cytopathologist performing the aspirate and issuing an immediate report. 2,5,9 This technique we have termed near patient FNA diagnosis (NPFD) to emphasize the proximity between the patient and the cytologic diagnostic process in time and place.…”

Accuracy of Fine-Needle Aspiration of Breast Masses and Comparison with Palpation and Mammography

“…In this study, physical examination and mam mography had lower specificities in compari son to cytology due to the false-positive and false-suspicious diagnoses. However, false positive diagnoses have been recorded in FNA, even by experienced cytopathologists [6,7], To avoid an unnecessary mastectomy due to a false-positive cytodiagnosis, a diag nostic triplet of palpation, mammography and FNA is suggested [4,[8][9][10][11][12], Only a com bination of positive reports is sufficiently spe cific to warrant definite therapy without a fro zen section [4,8,12], However, as rare breast tumors with a false-positive triplet have been reported, some centers prefer to perform fro zen sections for breast tumors even with a positive triplet result [13,14], False-negative reports of breast masses are more difficult to avoid in cytodiagnosis due to sampling errors [5]. Sensitivity of cytology ranged from 70 to 99% (3-35% of false nega tive results) [1,5,14].…”

Fine needle aspiration cytology (FNAC) in pre-operative diagnosis of breast lesions in Kadapa region of Andhra Pradesh, India

“…The fine needle aspiration cytology has become the investigation of choice for the diagnosis of the breast malignancy. 1,2 Fine needle aspiration cytology is defined as the study of cells obtained by a fine needle under vacuum. The specimen consists of a minute quantity of tissue or fluid.…”