The value of fine needle aspiration biopsy in the diagnosis and prognostic assessment of palpable breast lesions

Abstract

In recent years there appears to be a growing movement toward the use of core needle biopsy (CNB) over fine needle aspiration biopsy (FNAB) for the detection of breast carcinoma. This tendency is caused in part by the idea that CNB can provide a more specific or definitive diagnosis as well as the belief that the assessment of prognostic/predictive factor is not possible or reliable on cytologic specimens. At our institution, FNAB of breast has been practiced for over 25 years with excellent cytologic-histological correlation. This practice has been beneficial not only for patients, but also for training physicians since nowadays a very small number of centers in the United States still routinely perform fine needle aspiration as a diagnostic tool in breast cases. To assess the diagnostic accuracy of FNAB in palpable breast lesions, we reviewed our experience during an 8-year-period and compared fine needle aspiration results with follow-up surgical specimens. From the cytology point of view, the lesions were divided as negative/benign, atypical/suspicious, positive, and insufficient. Only cases performed by pathologists were included. A total of 1,583 cases were retrieved from our archives. A definitive malignant diagnosis was reached in 357 cases. One-hundred and thirty-nine cases were classified as atypical/ suspicious, 135 cases had insufficient cells for establishing a diagnosis, and 952 were categorized as negative. A total of 408 follow-up surgical specimens were available for comparison with cytologic results. There were 19 false-negative, and no false-positive results were found. The majority of false-negative results were secondary to sampling errors. In 93% of the malignant cases, there was enough material obtained in cytological specimens to perform prognostic/predictive factors studies. Our data proves once again that FNAB is a reliable method for the initial evaluation and diagnosis of palpable masses of the breast. In addition, it also has the ability of providing necessary prognostic/predictive information, particularly for patients that may undergo neoadjuvant therapy.