BREAST CYTOPATHOLOGY

Technical Aspects 3
review, breast FNA accounted for 6% of all pathology-related
claims (compared with breast biopsy resulting in 14% of
claims). Overall, when combined (FNA, biopsy, and frozen
section), almost 22% of all pathology claims are related to
misdiagnoses involving breast. Overdiagnosis (rather than
underdiagnosis) by either FNA or core is the most common
reason, resulting in 54% of these claims. False-negative breast
FNA results in that study were most commonly due to inadequate
sampling. A sparsely cellular aspirate was miscalled
“negative” or “fibrocystic changes.” Most of these claims
could have been avoided if they were initially called “nondiagnostic
FNA.” This is particularly important if the pathologist
is not the actual aspirator and is not familiar with the
clinicoradiologic findings of the case. One of the recommendations
from published literature in these scenarios is to
remind the clinicians (by adding a statement at the end of
every FNA report) that there is a 3%–5% false-negative and
a 0.5%–2% false-positive rate associated with breast FNA.
Although this statement may reinforce in the clinician’s mind
the benefit of exercising the “triple test” strategy when dealing
with a breast FNA report of these cases, most practicing
pathologists (including the authors) do not believe that such
a statement is routinely needed. Good communication with
the radiologist or surgeon in questionable cases is more beneficial.
A biopsy is strictly indicated if there is any discordance
between FNA findings and the clinical or radiologic characteristics
of the lesion. It is always a good idea for the pathologist
to review the other two elements of this triple test (clinical
and radiologic findings) and discuss them with the clinician
before finalizing the report. The most common reason for a
false-positive diagnosis is an interpretive error most often
involving a fibroadenoma.
Technical Aspects
Technically, breast FNA is not difficult to perform. However,
the procedure requires considerable experience and should
be done in conjunction with other diagnostic studies. It is