BREAST CYTOPATHOLOGY

8 1. Introduction and Technical Aspects
Clinical indications for breast fine-needle aspiration.
• Diagnostic
Inflammatory diseases (uncommon)
Primary neoplasms (benign vs. malignant)
Secondary or metastatic tumors (including hematologic/lymphoid
malignancies)
Atypical epithelial lesions (require further studies)
Tumor recurrence
• Therapeutic
Evacuation of simple/inflammatory cysts
Advantages of breast fine-needle aspiration.
• Economical/cost-effective outpatient procedure
• Minimally traumatic (physically and psychologically)
• High acceptance rate (by clinicians and patients)
• Rapid and accurate/sensitive assessment (within minutes)
• Informed pretreatment planning with the patient
• Sampling of tumor for biomarkers/molecular/ancillary studies
• Evaluation of multiple nodules/lesions
• Accurately distinguishes mastitis from inflammatory carcinoma and
intramammary lymph nodes from true epithelial lesions, particularly in
the area of the tail of the breast
• Avoidance of open biopsy in nonneoplastic lesions, inoperable lesions,
or tumor recurrence
• May offer curative relief by cyst evacuation
• Accurate and rapid assessment of tumor recurrence in locally advanced
cancer (particularly chest wall recurrence) for better tumor staging
Major limitations of breast fine-needle aspiration.
• Inability to reliably distinguish between in situ and invasive breast
carcinomas (all histologic subtypes)
• Accuracy often dependent on the size of the lesion (less sensitive below
5 mm)
• Low accuracy in tumors that are predominantly cystic/necrotic,
hemorrhagic, desmoplastic, or located deep in the breast
• Lack of specific diagnosis for most benign lesions
• Need to biopsy all lesions with atypical gray zone diagnoses