BREAST CYTOPATHOLOGY

14 1. Introduction and Technical Aspects
Indications for image-guided fine-needle aspiration/core biopsies of
nonpalpable breast lesions.
• Based on the availability of high-quality breast imaging and a physician
trained to interpret the findings
• Prior to image-guided biopsy, the following steps are indicated:
A complete lesion evaluation by imaging studies
A careful physical evaluation of the area of concern
• Lesions for needle core biopsies include those that are highly suggestive
or suspicious for malignancy and some that have a low suspicious index
but for which follow-up imaging is not feasible
• All imaging findings should be documented and procedure report made
available
• Imaging results and cytopathologic/histopathologic findings should be
concordant. Further work-up is needed if there is disconcordance and a
follow-up recommendation made by the physician who performed the
biopsies
• There should be documentation of communication among the physician
performing the biopsy, the referring physician, and the patient
• All false-positive and false negative results should undergo follow-up
image-guided needle biopsy
Source: Based on data presented at the 1996 National Cancer Institute–
sponsored conference.
Specimen adequacy for breast fine-needle aspiration (FNA).
• Solid lesions
No specific requirement for a minimum number of epithelial cells
Aspirator assumes the responsibility of sample adequacy based on the
judgment that the FNA findings in the report are consistent with the
clinical/radiographic findings
Pathologist assumes the responsibility of ensuring that the cytologic
material/smears were interpretable and free from extensive artifacts
The amount of epithelial cells (few, moderate, abundant) should be
reported, as well as any other cellular elements
Individual laboratories may consider specific cell count as their own
criterion. There is no national standard requiring a minimal count
• Cystic lesions
There are no criteria for a minimal cell count. If fluid is thin, watery,
and not bloody, the fluid is examined or discarded at the aspirator’s
discretion if the FNA completely evacuates the cyst and there is no
residual palpable mass left
Any residual mass/nodule requires repeated FNA
Cysts with brown/reddish fluid (if not related to trauma of the FNA)
require careful evaluation or further work-up
Source: Based on data presented at the 1996 National Cancer Institute–
sponsored conference.