Statistical analysis of diagnostic failure of fine needle aspiration cytology (FNAC) in breast cancer

Savic

et al. 2006

Cancer

BACKGROUND. Equivocal atypia in respiratory cytology can be a diagnostic challenge. In such cases fluorescence in situ hybridization (FISH) may be used for the analysis of chromosomal aberrations and often allows a reliable distinction of benign and malignant cells. METHODS. An online picture gallery of 30 respiratory cytologic preparations comprising 23 specimens with equivocal cytology as well as 5 positive and 2 negative controls was prepared (http://www.unibas.ch/patho/lungenzyto/loesung/). The final diagnoses were confirmed by clinical follow‐up or biopsy or both. Each of the illustrated cell groups was analyzed by multitarget FISH after PAP image capturing and automatic relocalization. RESULTS. The online questionnaire was completed by 137 cytomorphologists from all continents. The control cases were assessed accurately to a significantly higher percentage than the equivocal cases. In equivocal cases participants more often made false‐positive than false‐negative diagnoses. In 2 patients with benign conditions (tuberculosis and pulmonary capillaritis) the rate of false‐positive answers was remarkably high (31.4% and 62.8% respectively). The result of the 20 best‐performing participants for the 5 cases with the highest percentage of inaccurate answers was not better than if they had chosen their answer by chance. CONCLUSIONS. These data illustrate that single cells or cell clusters of a subgroup of equivocal lung cytology are a diagnostic challenge even for highly experienced morphologists. Internet‐based tests are able to reveal limitations of cytomorphology. Cancer (Cancer Cytopathol) 2006; © 2006 American Cancer Society.

Section: Discussionmentioning

confidence: 99%

An online quiz uncovers limitations of morphology in equivocal lung cytology

Savic

et al. 2006

Cancer

“…FNA cytology is an established technique for the preoperative diagnosis of breast lesions 10–13 . The method is well accepted by the patients and allows a cytological diagnosis, as well as ancillary studies of hormone receptor content and cell proliferation.…”

Section: Introductionmentioning

confidence: 99%

Hormone receptor status in breast cancer – a comparison between surgical specimens and fine needle aspiration biopsies

et al. 2003

The present study was performed to evaluate the immunocytochemical analysis (ICA) of oestrogen (ER) and progesterone receptor (PR) in fine needle aspiration (FNA) biopsies from primary breast cancers as compared with the established enzyme immunoassays (ER-EIA and PR-EIA) based on cytosol homogenates from the corresponding resected tumour specimens. A total of 967 primary breast cancers were assessed for ER and PR content by both methods. Correlations between EIA and ICA expressed as percentage of tumour cells with a positive staining were highly significant (P < 0.001) for ER and PR. Staining intensity yielded only limited additional information. The concordance between the two techniques was about 80%. Evaluation of biological parameters by FNA may be useful to decide the optimal treatment for breast cancer patients.

“…The panel noted that it is critically important to recognize the inherent limitations of FNAB, such as sampling error and difficult interpretation in a small, but significant number of cases with certain lesions. These lesions include atypical hyperplasia, low‐grade carcinoma, papillary lesions, and fibroepithelial tumors (32). In addition, FNAB cannot reliably distinguish between invasive and noninvasive breast cancer (33).…”

mentioning

confidence: 99%

Diagnosis of Breast Cancer in Countries with Limited Resources

et al. 2003

Accurate diagnosis is a necessary step in the management of breast cancer. In women with breast cancer, diagnosis can confirm the presence of the disease, reduce treatment delays, and clarify the predictive and prognostic features of the cancer, which help in planning treatment and counseling women. In women with benign breast conditions, accurate diagnosis avoids erroneous treatment for breast cancer, which can have devastating consequences for the woman and unnecessarily consumes resources. The panel distinguishes between a "clinical diagnosis" of breast cancer (one based on signs and symptoms and imaging findings) and a "pathologic diagnosis" of breast cancer (one based on microscopic examination of cellular or tissue samples). The panel agrees that all women should have a pathologic diagnosis of breast cancer before they are given definitive treatment for the disease, no matter how strongly their clinical findings suggest cancer. The tools for clinical diagnosis include history, clinical breast examination, ultrasound, and diagnostic mammography; these tools provide valuable information and play important supplemental roles in ascertaining the presence of breast cancer. Mammography and ultrasound also help determine the extent of disease within the breast, which is essential when breast-conserving therapy can be offered to women. The tools for pathologic diagnosis include fine-needle aspiration biopsy, core needle biopsy, and standard surgical biopsy. The panel noted that each of these tools has potential benefits and limitations in the limited-resource setting, and concluded that the choice among them must be based on the available tools and expertise. The triple test-checking for correlation of pathology findings, imaging findings, and clinical findings-was identified as a critical practice in diagnosing breast cancer. Panelists uniformly agreed that mastectomy should not be used to diagnose breast cancer, noting that accurate diagnosis can be made by less invasive means. Expertise in pathology was identified as a key requirement for ensuring reliable diagnostic findings. Several approaches were proposed for improving breast pathology, including training pathologists, establishing pathology services in centralized facilities, and organizing international pathology services.