A Retrospective Study of the Diagnostic Accuracy of Fine-Needle Aspiration for Breast Lesions and Implications for Future Use
Department of Pathology and Lab Medicine, David Geffen Medical School, Center of Health Science, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095-1732, USA.Diagnostic Cytopathology (Impact Factor: 1.12). 12/2008; 36(12):855-60. DOI: 10.1002/dc.20933
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.
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ABSTRACT: Angiosarcoma of the breast is an uncommon, aggressive, vascular tumor. The cytomorphologic features of angiosarcomas have rarely been reported. The present study describes a case of breast angiosarcoma initially diagnosed by fine needle aspiration cytology. Angiosarcoma appeared in the left breast of a 58-year-old woman after 12 years of a mastectomy (without radiotherapy) of the contralateral breast for invasive ductal carcinoma. Fine needle aspiration cytology yielded very bloody material with moderate cellularity. Microscopically, two types of cells were observed: spindle cells and epithelial-like cells with nuclear atypia. The latter were arranged in tight clusters with papillary configuration. Both cell types exhibited immunoreactivity for endothelial markers. The diagnosis of angiosarcoma was confirmed by histopathology of the surgically excised tumor. Angiosarcoma rarely occurs in the breast, and a definitive diagnosis is extremely difficult relying exclusively on cytologic features. Predominance of epithelioid cells may suggest an epithelial tumor, especially in patients with a history of breast carcinoma, whereas predominance of spindle cells can be misinterpreted as phyllodes tumor or another type of sarcoma. Cell block immunocytochemistry and tumor cell labeling with endothelial markers are necessary for accurate diagnosis.
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ABSTRACT: To evaluate the accuracy and diagnostic performance of fine needle aspiration FNA cytology in diagnoses of breast masses. Women who had FNA diagnoses for breast masses and underwent subsequent histopathologic evaluation during January 2003-December 2006 were accessed from the archive of the Anatomical Pathology Department of our institution. Cytologic diagnoses were classified as unsatisfactory, benign, atypical probably benign, suspicious probably malignant, and malignant, and were compared to the histopathologic diagnoses obtained from core needle biopsy, excisional biopsy, or mastectomy to give an assessment of the diagnostic performance of FNA. A series of 190 breast masses were identified during the study period. The FNA cytological diagnosis was unsatisfactory due to inadequate specimens in eight cases (4.2%). The diagnoses in the remaining 182 cases were: benign lesions in 98 (53.9%); suspicious for malignancy in 31 (17.0%); and malignant in 53 (29.1%). From the subsequent histopathologic diagnoses, 6/98 cases of benign cytology turned out to be malignant lesions (false negatives); 22/31 cases of suspicious cytology were truly malignant while the other nine were benign; and only 1/53 with malignant cytology was benign (false positive), the lesion being a fibroadenoma . The overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 91.2% (95% confidence interval (CI), 87.6%-94.8%), 92.5% (95% CI, 88.7%-96.3%), 90.2% (95% CI, 85.9%-94.5%), 88.1% (95% CI, 83.4%-92.8%) and 93.9% (95% CI, 90.4%-97.4%), respectively. FNA cytology is highly accurate for diagnosis of breast masses. However, the clinician should correlate FNA cytological results with physical examination and imaging findings to prevent false negative and false positive events and to obtain optimal management for their patients.
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