Fine-Needle Aspiration in Breast Cancer Staging

Abstract

While fine-needle aspiration (FNA) is no longer the standard for the primary diagnosis of breast cancer, the quasi-immediate cytological diagnosis of another minute focus of cancer in another quadrant of the breast and the diagnosis of an early lymph node metastasis via a 30-second FNA have revolutionized the local and regional staging of invasive breast cancer. At MD Anderson Cancer Center, we have used ultrasound (US) and US-guided FNAs successfully for three decades for this purpose, and US-guided FNAs represent about half of all US-guided needle biopsies performed in our section on new patients presenting with breast cancer. This chapter covers the use of FNA to confirm multifocal and multicentric disease as part of the local staging of breast cancer and describes in detail the techniques and strategies of US-guided FNA of suspicious nodes in the various regional nodal basins. US and US-guided FNA provide the most effective regional staging of breast cancer available today. The occasional US detection and diagnosis via US-guided FNA of a distant metastasis are also covered.