Everything You Always Wanted To Know about Core Wash Cytology in a Same-Day Breast Clinic * but Were Afraid To Ask.

Abstract

Abstract Background.The histologic core needle biopsy (CNB) diagnosis is gaining importance in the initial diagnostic workup of breast lesions. However, CNB diagnosis requires 24 hours of processing while cytology can allow diagnosis within 1 hour. A quick reliable preliminary diagnosis is essential in the management of the one-day breast clinic.After a successful preclinical study investigating the diagnostic potential of an alternative method of core wash cytology, this method has now been introduced into the clinical setting.1 We hereby present the first data.Materials and methods.From April 2008 to April 2009, ultrasound guided biopsies were obtained from all palpable and non-palpable lesions in the female breast in our institute. Core wash cytology was derived from the CNB with the modified technique and classified in the categories proposed by the 1996 National Cancer Institute-sponsored conference approach: malignant, suspicious for malignancy, atypical, benign and unsatisfactory. The results of the core washes and the CNBs were correlated with the histopathology of subsequently obtained resection specimens. Suspicious for malignancy and malignant was considered as positive. Sensitivity and specificity were calculated.Results.Core wash cytology was obtained from 226 breast lesions. The age of the patients ranged from 21-92 years (median 57,5 years). In 167 of these cases subsequent resection of the lesion was performed in the follow-up. The specimens revealed 149 carcinomas (ductal 111, lobular 24, mucinous 4, tubular1, medullary 1, papillary 1 and 7 intraductal carcinoma grade 2/3). Of the 149 malignant cases 136 were classified as either malignant or suspicious for malignancy on core wash cytology, 7 cases were classified as atypical, 4 as benign and 2 as unsatisfactory. The remaining 18 resected cases were benign (adenosis 4, benign fibrous tumors 9, intracystic papilloma 1, mastitis 1, fat necrosis 2 and 1 mammary duct ectasia). None of the benign lesions were classified as suspicious or malignant on core wash cytology. Eleven lesions were classified as benign, 3 as atypical and 4 as unsatisfactory on core wash cytology. The sensitivity and specificity of the core wash compared to the definite resection diagnosis were 90% and 100%, respectively (95% confidence interval: 86%-95%).Comparing the core wash diagnoses to those on CNBs in the group of 149 resected carcinomas, it was noted that in 8 cases, which were negative on CNB, 5 cases revealed positivity on core wash cytology.Conclusion.The introduced modified technique on core wash cytology can provide a reliable preliminary indication of the likely CNB diagnosis. The modified core wash cytology is a sensitive and quick method for the detection of malignant breast lesions. This information is valuable for same-day patient counselling and management planning.Furthermore, combining core wash cytology with CNB findings can lead to an increase in the number of positive preoperative diagnoses in malignant lesions of the breast.So, don't be reluctant or afraid to implement cytology in the diagnostic work-up of breast lesions.Accepted for publication February 2009 in Cancer Cytopathology Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6017.