Is FNA Still a Useful Tool in the Diagnosis of Breast Masses? A 5-Year Review with Cytohistopathologic Correlation
Keywords:
fine needle aspiration cytology, breast, cytohistopathological correlationAbstract
Introduction. Breast cancer is the most common cancer among women worldwide. In the Philippine National Cancer registry, 1 in every 13 Filipino women is likely to suffer from breast cancer. Fine needle aspiration cytology (FNAC) is a safe, accurate, fast and economical technique practiced worldwide in breast cancer diagnosis.
Objective. To assess the value of FNAC as a rapid diagnostic tool in the local setting with the expectation to provide an immediate and highly reliable diagnosis in more than 90% of breast lesions.
Methodology. From January 2010 to December 2014, there were 306 out of 1465 breast FNAC documented cases with histopathological correlation. The FNAC smears were retrieved, retrospectively reviewed blindly and reclassified into 5 categories (C1- C5). All FNAC were performed by pathology residents, pathologists and cytopathologist. Smears were fixed in 95% ethyl alcohol and stained with Papanicolaou method.
Results. The FNAC findings showed: 13 (4.25%) unsatisfactory (C1); 160 (52.29%) benign (C2); 23 (7.52%) atypical (C3); 9 (2.94%) suspicious (C4) and 101 (33.01%) malignant cases (C5). There were 120 (39.22%) malignant and 186 (60.78%) benign lesions. There were 3.92% (12/306) false negative and 0.65% (2/306) false positive cases.
The FNAC had 90% sensitivity, 99% specificity, 98% positive predictive value, 99% negative predictive value and 95% accuracy. The risks of malignancy for each category were: C1=15%; C2=4%; C3=13%; C4=78% and C5=100%.
Conclusion. Despite the increasing preference for core needle biopsy among surgeons, FNAC continues to be an acceptable, affordable, quick and valuable tool contributing significantly to early breast cancer diagnosis and treatment, particularly in developing countries like the Philippines. Owing to its high sensitivity and specificity, it can be used as a screening and confirmatory diagnostic tool. Malignant and benign interpretations of breast FNAC give highly accurate prediction of outcomes but must be correlated with clinical and mammographic findings.
Downloads
References
2. Feoli F, Paesmans M, Van Eeckhout P. Fine needle aspiration cytology of the breast: impact of experience on the accuracy, using standardized cytologic criteria. Acta Cytol. 2008:52(2):145-151. https://doi.org/ 10.1159/000325472.
3. Nagar S, Iacco A, Riggs T, Kestenberg W, Keidan R. An analysis of fine needle aspiration versus core needle biopsy in clinically palpable breast lesions: a report on the predictive values and cost comparison. Am J Surg. 2012;204(2):193-198. https://doi.org/10.1016/j.amjsurg.2011.10.018.
4. National Breast Cancer Centre. Breast fine needle aspiration cytology and core biopsy: a guide for practice. Camperdown, NSW, Australia: National Breast Cancer Centre, 2004. https://canceraustralia.gov.au/sites/default/files/publications/fna-fine-needle-aspiration-cytology-and-core-biopsy-guide-for-practice_504af03488799.pdf
5. Mendoza P, Lacambra M, Tan PH, Tse GM. Fine needle aspiration biopsy of the breast: the non-malignant categories. Patholog Res Int. 2011;2011:547580. https://doi.org/10.4061/2011/547580.
6. Zakhour H, Wells C. Diagnostic cytopathology of the breast. London, UK: Churchill Livingstone. 1999;8:261–6.
7. Koss LG. The palpable breast nodule: a cost-effectiveness analysis of alternate diagnostic approaches. The role of the needle aspiration biopsy. Cancer. 1993, 72(5):1499-502. PMID: 8348484.
8. Rubin M, Horiuchi K, Joy N, Haun W, Read R, Ratzer E, et al. Use of fine needle aspiration for solid breast lesions is accurate and cost-effective. Am J Surg. 1997; 174(6)694- 8. PMID: 9409599.
9. Nguansangiam S, Jesdapatarakul S, Tangjitgamol S. Accuracy of fine needle aspiration cytology from breast masses in Thailand. Asian Pac J Cancer Prev. 2009;10(4):623–6. PMID: 19827882.
10. Akçil M, Karaağaoğlu E, Demirhan B. Diagnostic accuracy of fine-needle aspiration cytology of palpable breast masses: an SROC curve with fixed and random effects linear meta-regression models. Diagn Cytopathol. 2008;36(5):303- 10. https://doi.org/ 10.1002/dc.20809.
11. Britton PD, Flower CDR, Freeman AH, Sinnatamby R, Warren R, Goddard MJ, et al. Changing to core biopsy in an NHS breast screening unit. Clin Radiol. 1997;52(10):764-7. https://doi.org/10.1016/S0009-9260(97)80156-0.
12. Cobb CJ, Raza AS. Obituary: “Alas poor FNA of breast we knew thee well!”. Diagn Cytopathol. 2005;32(1):1-4. https://doi.org/10.1002/dc.20189.
13. Chaiwun B, Settakorn J, Ya-in C, et al. Effectiveness of fine-needle aspiration cytology of breast: analysis of 2,375 cases from northern Thailand. Diagn Cytopathol. 2002;26(3):201-5. https://doi.org/10.1002/dc.10067.
14. Chaiwun B, Sukhamwang N, Lekawanvijit S, Sukapan K, Rangdaeng S, Muttarak M, et al. Atypical and suspicious categories in fine needle aspiration cytology of the breast: histological and mammographical correlation and clinical significance. Singapore Med J. 2005;46(1):706-9. PMID: 16308644.
15. Laudico AV, Esteban DB, Reyes LM, Liquido JC. Philippine Cancer Facts and Estimates. Manila: Philippine Society, Inc., 1998, pp. 24–25.
16. Matsuda MLDL, Laudico AV, Yosuico VED, Roxas FTR, Cabaluna ND, Blanco FJ. Evidence-based Clinical Practice Guidelines on the Diagnosis and Management of breast cancer part I. Early breast cancer. Philippine General Hospital, 2000, 2-12. http://pcs.org.ph/wp-content/uploads/2013/01/ebcpg_breast1.pdf.
17. Patel JJ, Gartell PC, Guyer PB, Herbert A, Taylor I. Use of ultrasound localization to improve results of fine needle aspiration cytology of breast masses. J R Soc Med. 1988;81(1):10-12. PMCID: PMC1291418.
18. Yeoh GPS, Chan KW. Fine-needle aspiration of breast masses: an analysis of 1533 cases in private practice. Hong Kong Med J. 1998;4(3):283-7. http://www.hkmj.org/system/files/hkm9809p283.pdf.
19. Padel AF, Coghill SB, Powis SJ. Evidence that sensitivity is increased and the inadequacy rate decreased when pathologists take aspirates for cytodiagnosis. Cytopathology. 1993;4(3):161-5. https://doi.org/ 10.1111/j.1365-2303.1993.tb00081.x.
20. Cohen MB, Rodgers RP, Hales MS, Gonzales JM, Ljung BM, Beckstead JH, et al. Influence of training and experience in fine-needle aspiration biopsy in breast. Receiver operating characteristic curve analysis. Arch Pathol Lab Med. 1987;111(6):518-20.
21. Ljung BM, Drejet A, Chiampi N, Jeffrey J, Goodson WH III, Chew K, et al. Diagnostic accuracy of fine-needle aspiration biopsy is determined by physician training in sampling technique. Cancer. 2001;93(4):263-8. https:// doi.org/ 10.1002/cncr.9040.
22. Alwahaibi NY, Alfahdi HA, Bai UR. Fine needle aspiration cytology of 108 breast lesions with histopathologic correlation: a retrospective study. Annu Res Rev Biol. 2014;4(21):3244-50. https://doi.org/10.9734/ARRB/2014/10538.
23. Kontzoglou K, Moulakakis KG, Konofaos P, Kyriazi M, Kyroudes A, Karakitsos P. The role of liquid-based cytology in the investigation of breast lesions using fine-needle aspiration: a cytohistopathological evaluation. J Surg Oncol. 2005;89:75-8. https://doi.org/10.1002/jso.20190.
24. Ueng SH, Mezzetti T, Tavassoli FA. Papillary neoplasms of the breast: A review. Arch Pathol Lab Med. 2009;133:893-907. http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165-133.6.893.
25. Agoff SN, Lawton TJ. Papillary lesions of the breast with and without atypical ductal hyperplasia can we accurately predict benign behavior from core needle biopsy? Am J Clin Pathol. 2004:122(3):440-443. https://doi.org/10.1309/NAPJMB0GXKJC6PTH.
26. Paramesh, Angshuman S, Kariappa TM. Correlation of fine needle aspiration cytology and histopathology in palpable breast lesions in 100 patients of KVG Medical College & Hospital, Sullia, Karnataka. International Journal of Applied Research. 2015;1(8);422-7. http://www.allresearchjournal.com/archives/2015/vol1issue8/PartG/1-8-48.pdf.
27. Mahajan NA, Bhale CP, Mulay SS. Fine needle aspiration cytology of breast lesions and correlation with histopathology – a 2 year study. Int J Health Sci Res. 2013;3(2):55-65.
28. Chokshi MH, Mehta NP. Cytological study of palpable breast lumps (407 cases) with their histological correlation. Int J Med Sci Public Health. 2014; 3(2); 181-185. http://10.5455/ijmsph.2013.191120134.
29. Shah PM, Vekariya PN, Bhalara R, Talwelker S, Dhruva G. Histocytological correlation study of breast lesion: a study of 150 cases. International Journal of Scientific Research. 2014;3(11):381-2.
30. Chaiwun, B and Thorner P. Fine needle aspiration for evaluation of breast masses. Curr Opin Obstet Gynecol. 2007;19(1):48-55. PMID: 17218852. https://doi.org/10.1097/GCO.0b013e328011f9ae.
31. Medina-Franco H, Abarca-Pérez L, Cortés-González R, Soto-Germes S,Ulloa JA, Uribe N. Fine needle aspiration biopsy : institutional experience. Rev Invest Clin. 2005;57(3):394-8. PMID:16187698.
32. Choi YD, Choi YH, Lee JH, Nam JH, Juhng SW, Choi C.Analysis of fine needle aspiration cytology of the breast: a review of 1,297 cases and correlation with histologic diagnoses. Acta Cytol. 2004;48(6): 801-6. PMID: 15581165.
Published
How to Cite
Issue
Section
License
The Philippine Journal of Pathology is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Based on works made open access at http://philippinejournalofpathology.org
@philippinepathologyjournal