How stereotactic core-needle biopsy affected breast fine-needle aspiration utilization: An 11-year institutional review

Core needle biopsy versus fine needle aspiration biopsy in breast--a historical perspective and opportunities in the modern era

Breast fine-needle aspiration biopsy (FNAB) by palpation is on the decline, due to its limitations in diagnostic accuracy, decreased sensitivity, and its replacement with core needle biopsy (CNB). Despite its decreasing utility, superficial fine-needle aspiration (FNA) in breast is still the main modality for evaluating metastatic lesions, recurrence, and axillary lymph node metastasis. New modalities including proteomic pattern expression and methylation profiling of breast lesions are other promising techniques that can be used as ancillary tests for refining the diagnosis of breast lesions using FNAB. Image-guided breast FNA proves to be a successful alternative with high sensitivity and specificity. In this review, the advantages, disadvantages, and inherent limitations of breast FNA and CNB, and new advanced techniques are discussed.

Rapid cell blocks improve accuracy of breast FNAs beyond that provided by conventional cell blocks regardless of immediate adequacy evaluation

A new "rapid cell block" technique (RCB; the predecessor of Cellienttrade mark Automated Cell Block System) is efficient at recovering sparse material. We previously found that RCBs of breast fine-needle aspirations (FNAs) frequently allow histologic classification of problematic ductal proliferative lesions. Previous studies that did not emphasize cell blocks found that on-site evaluation (OSE) of breast FNAs improves diagnosis. The purpose of this study was to determine if RCB could replace the utility of OSE of breast FNAs. The study included 604 consecutive ultrasound-guided noncyst breast FNAs composed of three cohorts based on the presence or absence of immediate adequacy assessment, conventional (collodion bag) cell blocks (CCB), and RCB. The cohort with OSE together with CCB did not perform as well as the cohort without OSE but with RCB. In a third cohort, performance characteristics of RCBs and CCBs were compared in an independent review by two cytopathologists blinded to the final cytology and follow-up histology diagnosis. By itself, the RCB histologic section was diagnostic 97% of the time, and it provided a diagnostic accuracy superior to CCB by itself and comparable to that provided by the combination of the smears with CCB. Highest accuracy was obtained by combining smears/monolayer preparations and RCB. Replacing OSE with RCBs provided substantial cost savings and savings of time for cytopathologists, radiologists, and their assistants.

Breast Fine Needle Aspiration Biopsy: Prevailing Recommendations and Contemporary Practices

In 1996, a National Cancer Institute conference was held in Bethesda,Maryland to define parameters for the practice of breast fine needle aspiration (BFNA). Representatives of the American Society of Cytopathology, Papanicolaou Society of Cytopathology, American College of Radiology, American College of Obstetricians & Gynecologists, Society of Surgical Oncology, American Academy of Family Physicians, College of American Pathologists, National Consortium of Breast Centers, International Academy of Cytology, American Society of Clinical Pathologists, American Cancer Society, American College of Surgeons, and American Society for Cytotechnology developed and reviewed recommendations. These guidelines were referred to as "The Uniform Approach to Breast Fine Needle Aspiration Biopsy." This article reviews these recommendations and the contemporary evolution of the practice of BFNA since their original publication.