Diagnostic Cytopathology of the Breast

Abstract

By Hani Zakhour and Clive Wells, 272 pp, with 322 illus, London, England, Churchill Livingstone, 1999.As stated in the preface, “this book provides a comprehensive guide for the newcomer to breast cytopathology.” It is divided into 26 chapters with more than 600 images that describe a full spectrum of breast pathology, from benign lesions to common malignancies to rare entities of fine-needle aspirations of the breast. Important sections of the text include chapters on the fine-needle aspiration technique, as well as clinical findings and presentation. The first 8 chapters include other basic information, such as the various stains used in cytology or problems in techniques that may lead to false-positive or false-negative diagnoses. Additional chapters on prognostic factors and research, as well as chapters on quality assurance and statistics, are also useful. The section on quality assurance and statistics provides an added dimension to the book by bringing current literature and data to support the authors' points.Excellent pictures of cytology specimens give a more realistic interpretation of the specific entities rather than the often “too perfect to be true” photographs seen in similar texts. For some diseases, corresponding radiographs, gross pathology, and histology are also used to illustrate specific points. Moreover, the text is referenced well, allowing the reader to refer to original articles for specific criteria. The tables are easy to read and follow, which is important as a “working textbook by the microscope.”Although some may believe that accurate diagnosis and classification by fine-needle aspiration is not possible, the authors strive to dispel this myth. The material discussing normal breast tissue and benign lesions is very helpful in those cases in which the cytology diagnosis is atypical or suspicious, but the histologic confirmation is essentially negative. Such discussions on false-negative and false-positive diagnoses are very important in any cytopathology department for providing excellent patient care and for quality assurance purposes. This information is essential for the young patient whose clinically benign nodule yields a cellular aspirate that does not demonstrate the classic fibroadenoma or fibrocystic changes. The book addresses the use of wide-bore or core needle biopsy as well; the authors see it as a complementary technique rather than a replacement for fine-needle aspiration.This well-illustrated, superbly written textbook integrates clinical and pathologic information in such a way to facilitate accurate diagnosis. It is a comprehensive, practical book that can provide important information to practicing cytopathologists. However, it can also serve as an excellent reference for surgical pathologists, radiologists, surgeons, and residents alike.