Breast Cytology: Current Issues and Future Directions

Malini Harigopal, David C. Chhieng
2014 The Open Breast Cancer Journal  
Breast cytology, in particularly fine needle aspiration biopsy (FNAB), has been used for many years as a diagnostic tool for managing patients with breast lesions. In experienced hands, FNAB is highly sensitive and specific. Other benefits include its low cost, minimal invasiveness, and ability to provide same-day diagnosis. Despite all these benefits, FNAB has gradually been replaced by core needle biopsy (CNB) because of its high error rates when there is a lack of experienced
more » ... ced cytopathologists, its inability to distinguish between invasive and in situ carcinoma, and most importantly, its inability to provide adequate and suitable materials for quantitative evaluation of HER2 and other prognostic markers. Other uses of breast cytology include touch preparation cytology for intraoperative evaluation of sentinel lymph nodes and surgical margins of lumpectomy specimens and for providing same-day diagnosis of CNB. In addition, breast cytology, such as ductal lavage and nipple fluid cytology, has also found applications in risk assessment for women at high risk for developing breast cancer. With the increased utilization of molecular technologies, genomic and proteomic studies have been successfully applied to breast cytologic preparations. It would not be far fetched to predict that in the very near future, the clinical application of molecular analyses will be routine ancillary testing in breast cytology, thus allowing early cancer detection, and improved tumor characterization as well as prediction of patients' outcomes and therapeutic responses. FNAB include high error rates due to a lack of experienced cytopathologists at individual laboratories. In addition, the belief that the inability of FNAB to provide adequate and suitable samples for assessment of prognostic markers also contributes to the decline. Nevertheless, FNAB continues to be used worldwide, especially in developing countries, for the management of breast lesions [4] [5] [6] [7] [8] [9] [10] . Current Indications of FNAB in the Management of Breast Lesions Currently, the indications for FNA of breast lesions include 1. Evaluation of cystic lesions. 2. Diagnosis of recurrent or metastatic breast cancer. 3. Confirmation of locally advanced cancer. Axillary staging of patients with invasive breast cancer. Diagnostic Accuracy One of the arguments for the replacement of FNAB by CNB is the high error rate due to a lack of experienced cytopathologists. However, in experienced hands, FNAB is a highly accurate diagnostic procedure. Recent review demonstrates that breast FNAB has a sensitivity ranging from 76% to 99%, a specificity from 60% to 100%, and a diagnostic accuracy from 72% to 95% [12] . For palpable breast lesions, both the sensitivity and specificity are over 95% [13, 14] . While the specificity for both FNAB and CNB approaches 100%; FNAB may be more sensitive (97%) vs 90% for CNB in the diagnosis of palpable breast cancers [15] . For nonpalpable breast lesions, FNAB under image guidance is also comparable to image-guided CNB. In one study, 1,885 FNAB with ultrasound guidance of nonpalpable
doi:10.2174/1876817201002011081 fatcat:fuo4o5ipo5apvij4gencsn7l5q