In recent years, the use of fine-needle aspiration (FNA) in the diagnosis of breast lesions has declined in many institutions. We sought to evaluate the role of FNA for breast lesions and the annual rate of the procedure at our institution over a 4(1/2) year period (May 2002-October 2006). A total of 831 FNAs were performed, with 258 (31%) having histologic follow-up. The number of FNAs obtained was 159 from 5/02 to 4/03, 192 from 5/03 to 4/04, 194 from 5/04 to 4/05, 191 from 5/05 to 4/06, and 95 from 5/06 to 10/06. Each case was placed into one of four categories: nondiagnostic (9%), benign (77.5%), atypical/suspicious (5.5%), or malignant (8%). Surgical tissue was available for 37% of nondiagnostic cases, 22% of benign cases, 80% of atypical/suspicious cases, and 72% of malignant cases. The overall sensitivity and specificity for FNA was 83 and 92% respectively. The overall positive and negative predictive values were 83 and 92% respectively. There were no false-positive cases, indicating a positive predictive value of 100% for a Dx of malignancy. For cases with surgical follow-up, the false-negative rate was 5.4%. Although there is a national trend away from FNAs of breast lesion, this has not been the experience at our institution. Although FNA may not be ideal in the initial evaluation of suspicious lesions, we argue that FNA for clinically benign palpable lesions and recurrent carcinomas has significant value.
[Show abstract][Hide abstract] ABSTRACT: Fine-needle aspiration cytology (FNAC) is a simple, accurate, and safe procedure for the diagnosis of palpable breast lumps. The purpose of this study is to emphasis the utilization of FNAC in the Sudan and to evaluate our experience to identify the types of various breast lesions. A one year descriptive longitudinal study was conducted in Khartoum, Sudan. We obtained information (patient's personal data) and Fine-Needle Aspiration (FNA) samples, for 200 patients with palpable breast lesions. Subsequent tissue biopsies were taken from 131 patients of the 200 studied patients. Data were analyzed using a computer's SPSS program. Pearson chi-square test was used for statistical analyses. The diagnoses of the 200 breast FNAs were as follows: 61 (30.5%) were malignant, 5 (2.5%) were suspicious, and 134 (67%) were benign lesions. Subsequent histopathological examination was performed on 61 (100%) patients with malignant lesions, 5 (100%) of suspicious, and 65 (48.5%) patients of 134 patients with benign lesions. FNAC revealed a 92.6% sensitivity, a 95.2% specificity, a 95.5% positive predictive value, and a 92.2% negative predictive value. Of the 65 benign cases on cytology, five cases were found malignant on histopathology. FNAC of breast lesions is sensitive, specific, and highly accurate as the initial investigation of palpable breast lesions in a population of low resources and without screening program to diagnose breast cancer. We consequently encourage clinicians to embrace this procedure in the management of patients.
[Show abstract][Hide abstract] ABSTRACT: 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 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.
The Open Breast Cancer Journal 01/2010; 4(1). DOI:10.2174/1876817201002011081
[Show abstract][Hide abstract] ABSTRACT: Breast needle core biopsy (NCB) is now a standard diagnostic procedure in the triple assessment of screen detected breast lesions. However, unlike fine needle aspiration (FNA) cytology, information on the miss rate including false-negative diagnoses (FN) of malignancy (benign 'B2' or normal 'B1' NCB with a malignant outcome) is limited. METHODS: A large series of NCBs (121,742) performed over an 8-year period has been studied to assess the frequency and causes of missing a malignant diagnosis on NCB and to evaluate their impact on patients' management in the screening service. RESULTS: During the period of this study, 50,691 were diagnosed as B2 and 9599 were diagnosed as B1. Of those, 779 B2 and 919 B1 were diagnosed as malignant on the subsequent surgical specimens, respectively, giving a FN rate of 3.0%. However when year of diagnosis was taken into consideration, we found that during the period 1999-2001, the FN rate for B2 was 2.7% while the miss rate for B1 was 4.0%. This showed marked improvement over time to reach a figure of 0.5% and 0.5% for B2 and B1, respectively, during the period 2005-2007. On detailed review of cases from a single screening region diagnosed during the last 3 years (2005-2008), 14 cases (0.17% of all NCBs) with malignant surgery were diagnosed as B2 (seven cases; FN rate 0.19%) and B1 (seven cases; B1 biopsy rate from cancer 0.19%). In these cases, NCB was unsatisfactory, there was a discrepancy between radiological abnormalities and histological findings with recommendation for excision or suspicious/malignant cytological diagnosis on concurrent FNA material. Therefore, our results indicate that the malignancy miss rate on NCB is rare and FN NCB diagnoses had no impact on patient management.
European journal of cancer (Oxford, England: 1990) 04/2010; 46(10):1835-40. DOI:10.1016/j.ejca.2010.03.024 · 5.42 Impact Factor
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