The value of a second fine needle aspiration cytology in patients with breast masses

Abstract

In this edition of The Breast there are two articles on breast fine needle aspiration cytology (FNAC). The first from Ciatto’s group in Florence, Italy presents their experience of nearly 10 000 fine needle aspirations of the breast. The results are extremely impressive and emphasise the value of triple assessment (clinical examination, radiological imaging and cytology) in the diagnosis of breast disease. In their review, the overall positive predictive value for carcinoma when a suspicious report was recorded for each modality was 99.8%. Results such as these demonstrate convincingly the potential for FNAC (when used as part of the triple approach) in the accurate pre-operative diagnosis of breast cancer. This level of accuracy has led some groups to adopt similar policies for the diagnosis of benign breast disease. That is, if classified as benign or innocent in all three modalities, a lesion may be safely considered benign and the patient offered no further intervention. This is particularly applicable to breast screening practice where a high proportion of benign lesions are detected by mammography, excision of which would discredit such a population screening programme. The application of such an approach to symptomatic breast masses is more controversial, but has found acceptance in some centres. The second paper from Paraskevopoulos and colleages demonstrates the main concern about widespread use of such practice. If a single benign FNAC is sufficient to satisfy the cytological criteria for the conservative management of benign breast masses then occasional cancers may be missed and patients inappropriately reassured. This group advocate the need for a second benign FNAC sample before patients with probable benign disease have satisfied the triple approach criteria.