BREAST CYTOPATHOLOGY

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Introduction and Technical
Aspects
Brief History and Background
Needle aspiration cytology has been in use for many decades
and dates back at least to the early part of the nineteenth
century. Sir James Paget is credited for aspirating malignant
cells from a breast cancer patient in 1853. Much of the early
experience of aspiration biopsy was not with “fine” needles
but with larger bore cutting needles. The popularity of this
simple procedure has largely been because of its cost effectiveness
as well as the inherent qualities of the procedure itself:
low complication rate, rapidity, and high diagnostic accuracy.
The incidence of breast cancer in the United States has
risen, and early detection of breast cancer plays a pivotal role
in prognosis and survival. Palpable lesions can be effectively
biopsied using a thin needle (23 gauge or smaller) without
radiologic guidance. However, with the current trend of detecting
smaller, nonpalpable lesions, radiologic guidance (mostly
ultrasound) is needed to adequately sample smaller lesions.
The “triple diagnostic approach,” which consists of palpation,
radiologic findings, and cytopathologic analysis on fineneedle
aspiration (FNA), is applicable to benign, preneoplastic,
borderline, and malignant diseases of the breast. Controversy
continues about the use of breast FNA as the initial diagnostic
modality of choice. Many issues have arisen over the past
two decades that have affected the utility of this excellent
procedure, including the overuse or casual application of the
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