BREAST CYTOPATHOLOGY

4 1. Introduction and Technical Aspects
widely accepted that FNA should be done and interpreted in
the setting of known clinical data and mammographic studies.
This is known as the triple diagnosis or triple test. When FNA
is done in this setting, the need for a frozen section prior to
definitive surgery is reduced. Frozen sections may still be
needed, however, when the cytologic diagnosis is unsure or
is at odds with the clinical data.
The current technique of FNA uses a 23- to 25-gauge
needle, 1–1.5 inches long on a 10- to 20-mL syringe with or
without a syringe holder. The technique can be performed
with or without actual aspiration. Obtained material is
smeared on slides and either alcohol fixed for Papanicolaou
and hematoxylin and eosin or air dried for Romanowskytype
stains, which include Diff-Quik. Lately there has been
an increase in the use of liquid-based cytology preparations
in breast FNA. However, in our experience and in the
experience of many others, direct smears are generally
preferred to liquid-based preparations because larger cell
clusters/fragments and architecture are preserved on the
direct smears. It is sometimes suggested that liquid-based
preparations are preferred when the operator has little
experience and poor technique in the performance of FNA.
We do not agree with this, as there is little a liquid-based
preparation can do to make up for an inadequate sampling
of a breast lesion.
Cell blocks should be prepared whenever possible. We find
cell blocks superior to liquid-based preparations and direct
smears for ancillary studies, and they are especially useful in
estrogen receptor and progesterone receptor status determination.
They also provide a reservoir of material for future
studies.
On-site assessment of a fine-needle aspirate of palpable
lesions is desired. Feedback to the clinician for patient management,
the ability to make additional passes as needed
(e.g., when lymphoma is suspected), and greater likelihood
of optimal preparations are some of the benefits of immediate
assessment.
Fine-needle aspiration is indicated for almost all palpable
lesions to provide a rapid, accurate, and cost-effective diagnosis.