Skip to main content
PMC home page
Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1987 Jul;69(4):156–159.

Fine needle aspiration cytology of breast masses: an evaluation of its accuracy and reasons for diagnostic failure.

J J Patel, P C Gartell, J A Smallwood, A Herbert, G Royle, R Buchanan, I Taylor
PMCID: PMC2498449  PMID: 3631871

Abstract

A study of 1458 patients who had undergone breast aspiration cytology was conducted to determine the diagnostic accuracy of the technique. The effect of tumour histology and size on the unsatisfactory aspirate and false negative rate was examined. Seven hundred and thirty one patients (50%) had histological diagnoses. The sensitivity of aspiration cytology for malignancy was 64% for the first aspiration, but was 91% in patients who had had 3 aspirates. The specificity was 56%, this low figure was almost entirely due to inadequate or unsatisfactory cytological preparations. The positive and negative predictive values of aspiration cytology were 99.4% and 85% respectively demonstrating high diagnostic accuracy given a satisfactory aspirate. Invasive lobular carcinoma yielded a significantly higher unsatisfactory rate than invasive ductal carcinoma (P less than 0.001) and fibroadenoma yielded a significantly lower unsatisfactory rate than fibroadenosis (P less than 0.001). Mass size influenced the unsatisfactory rate for invasive ductal carcinoma (P less than 0.05) and fibroadenoma, but not for invasive lobular carcinoma or fibroadenosis. Only 2 of the 32 false negatives were due to misinterpretation, the remainder resulted from the aspiration needle missing the mass. We conclude that aspiration cytology is an accurate preoperative diagnostic procedure for the evaluation of breast masses. Unsatisfactory or negative aspirates should be regarded as 'non-results' if there is clinical or radiological suspicion of malignancy.

Full text

PDF
159

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abele J. S., Miller T. R., Goodson W. H., 3rd, Hunt T. K., Hohn D. C. Fine-needle aspiration of palpable breast masses. A program for staged implementation. Arch Surg. 1983 Jul;118(7):859–863. doi: 10.1001/archsurg.1983.01390070067013. [DOI] [PubMed] [Google Scholar]
  2. Citrin D. L., Hogan T. F., Davis T. E. A study of cyclophosphamide, adriamycin, cis-platinum, and methotrexate in advanced transitional cell carcinoma of the urinary tract. Cancer. 1983 Jan 1;51(1):1–4. doi: 10.1002/1097-0142(19830101)51:1<1::aid-cncr2820510102>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
  3. Davies C. J., Elston C. W., Cotton R. E., Blamey R. W. Preoperative diagnosis in carcinoma of the breast. Br J Surg. 1977 May;64(5):326–328. doi: 10.1002/bjs.1800640507. [DOI] [PubMed] [Google Scholar]
  4. Dixon J. M., Anderson T. J., Lamb J., Nixon S. J., Forrest A. P. Fine needle aspiration cytology, in relationships to clinical examination and mammography in the diagnosis of a solid breast mass. Br J Surg. 1984 Aug;71(8):593–596. doi: 10.1002/bjs.1800710809. [DOI] [PubMed] [Google Scholar]
  5. Duguid H. L., Wood R. A., Irving A. D., Preece P. E., Cuschieri A. Needle aspiration of the breast with immediate reporting of material. Br Med J. 1979 Jul 21;2(6183):185–187. doi: 10.1136/bmj.2.6183.185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Eisenberg A. J., Hajdu S. I., Wilhelmus J., Melamed M. R., Kinne D. Preoperative aspiration cytology of breast tumors. Acta Cytol. 1986 Mar-Apr;30(2):135–146. [PubMed] [Google Scholar]
  7. Franzén S., Zajicek J. Aspiration biopsy in diagnosis of palpable lesions of the breast. Critical review of 3479 consecutive biopsies. Acta Radiol Ther Phys Biol. 1968 Aug;7(4):241–262. doi: 10.3109/02841866809133198. [DOI] [PubMed] [Google Scholar]
  8. Gardecki T. I., Hogbin B. M., Melcher D. H., Smith R. S. Aspiration cytology in the preoperative management of breast cancer. Lancet. 1980 Oct 11;2(8198):790–792. doi: 10.1016/s0140-6736(80)90396-7. [DOI] [PubMed] [Google Scholar]
  9. Hajdu S. I., Melamed M. R. Limitations of aspiration cytology in the diagnosis of primary neoplasms. Acta Cytol. 1984 May-Jun;28(3):337–345. [PubMed] [Google Scholar]
  10. Norton L. W., Davis J. R., Wiens J. L., Trego D. C., Dunnington G. L. Accuracy of aspiration cytology in detecting breast cancer. Surgery. 1984 Oct;96(4):806–814. [PubMed] [Google Scholar]
  11. SMITH I. H., FISHER J. H., LOTT J. S., THOMSON D. H. The cytological diagnosis of solid tumours by small needle aspiration and its influence on cancer clinic practice. Can Med Assoc J. 1959 Jun 1;80(11):855–861. [PMC free article] [PubMed] [Google Scholar]
  12. Smallwood J., Herbert A., Guyer P., Taylor I. Accuracy of aspiration cytology in the diagnosis of breast disease. Br J Surg. 1985 Oct;72(10):841–843. doi: 10.1002/bjs.1800721022. [DOI] [PubMed] [Google Scholar]
  13. Smallwood J., Khong Y., Boyd A., Guyer P., Herbert A., Cooke T., Taylor I. Assessment of a scoring scheme for the preoperative diagnosis of breast lumps. Ann R Coll Surg Engl. 1984 Jul;66(4):267–269. [PMC free article] [PubMed] [Google Scholar]
  14. Somers R. G., Young G. P., Kaplan M. J., Bernhard V. M., Rosenberg M., Somers D. Fine-needle aspiration biopsy in the management of solid breast tumors. Arch Surg. 1985 Jun;120(6):673–677. doi: 10.1001/archsurg.1985.01390300023004. [DOI] [PubMed] [Google Scholar]
  15. Thomas J. M., Fitzharris B. M., Redding W. H., Williams J. E., Trott P. A., Powles T. J., Ford H. T., Gazet J. C. Clinical examination, xeromammography, and fine-needle aspiration cytology in diagnosis of breast tumours. Br Med J. 1978 Oct 21;2(6145):1139–1141. doi: 10.1136/bmj.2.6145.1139. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Van Bogaert L. J., Mazy G. Reliability of the cyto-radio-clinical triplet in breast pathology diagnosis. Acta Cytol. 1977 Jan-Feb;21(1):60–62. [PubMed] [Google Scholar]
  17. Wollenberg N. J., Caya J. G., Clowry L. J. Fine needle aspiration cytology of the breast. A review of 321 cases with statistical evaluation. Acta Cytol. 1985 May-Jun;29(3):425–429. [PubMed] [Google Scholar]
  18. Zajdela A., Ghossein N. A., Pilleron J. P., Ennuyer A. The value of aspiration cytology in the diagnosis of breast cancer: experience at the Fondation Curie. Cancer. 1975 Feb;35(2):499–506. doi: 10.1002/1097-0142(197502)35:2<499::aid-cncr2820350231>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

RESOURCES