Does fine-needle aspiration biopsy still have a place in the diagnosis of breast lesions?

Correlation Between Ultrasound BI-RADS 4 Breast Lesions and Fine Needle Cytology Categories in a Sample of Iraqi Female Patients

Background: Breast cancer is the most common malignancy in female and the most registered cause of women’s mortality worldwide. BI-RADS 4 breast lesions are associated with an exceptionally high rate of benign breast pathology and breast cancer, so BI-RADS 4 is subdivided into 4A, 4B and 4C to standardize the risk estimation of breast lesions.

The aim of the study: to evaluate the correlation between BI-RADS 4 subdivisions 4A, 4B & 4C and the categories of reporting FNA cytology results.

Patients and Methods: A case series study was conducted in the Oncology Teaching Hospital in Baghdad from September 2018 to September 2019. Included patients had suspicious breast findings and given BI-RADS 4 (4A, 4B, or 4C) in the radiological report accordingly. Fine needle aspiration was performed under the ultrasound guide and the results were classified into five categories. The biopsy was performed for suspicious, malignant or equivocal FNA findings.

Results: This study included 158 women with BIRADS 4 breast lesions with the mean age of (44.6 years); There was a highly significant association between BI-RADS 4 breast lesion and FNA results (p<0.001); 51.9% of BI-RADS IV-C had C5 FNA results. There was a highly significant association between BI-RADS 4 lesion and the final diagnosis (p<0.001); 41.2% of BI-RADS 4 B had a malignant breast lesion, while 37.3% of BIRADS 4 C had a malignant lesion.

Conclusion: A clear relationship was observed between BI-RADS 4 subcategories and the fine needle aspiration cytology subgroups. BI-RADS 4-B is helpful in the discrimination between benign and malignant breast lesions; furthermore BI-RADS 4C has more acceptable validity in the diagnosis of breast malignancy. Therefore, BI-RADS subcategories are encouraged to be included and mentioned in the ultrasound report for more accurate estimation of the lesion nature.

Beware of hemopneumothorax following core needle breast biopsy

Minimal diagnostic procedures are conducted regularly by the radiologists for several lesions within the body. The usual methodology is biopsy with a needle, either fine needle aspiration or core biopsy. The guidance is under CT or U/S. Fine needle aspiration has usually small diameter in comparison to the core biopsy. In any case the radiologist will choose the appropriate method based on the site of the lesion and safety of the patient. Pneumothorax and hemothorax are adverse effects that can be managed either on site with the help of a small catheter, however; there are cases where video-assisted thoracic surgery is needed in order to manage a more severe case. In the current study we present such a case where video-assisted surgery was necessary.