Overcoming Pitfalls in Breast Fine-Needle Aspiration Cytology: A Practical Review

Autores da FMUP

• 

  Fernando Carlos De Landér Schmitt

  Autor

Participantes de fora da FMUP

• Gomes Pinto D.

Unidades de investigação

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Patologia

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Background: Fine-needle aspiration cytology (FNAC) is a cornerstone technique for the initial assessment of breast lesions, offering a rapid and minimally invasive option for cytological evaluation. While FNACs can forego the need for core needle biopsies (CNBs), variations in technique, subjective interpretation, and intrinsic limitations present diagnostic challenges. The International Academy of Cytology (IAC) established the Yokohama system and is developing the WHO Reporting System for Breast Cytopathology jointly with IARC, to standardize diagnostic criteria, aiming to enhance diagnostic precision and consistency. Due to the preference for CNBs, expertise in breast FNAC is low in the developed world. Summary: This review assesses common pitfalls in breast cytopathology. These common and uncommon entities may easily lead to false-negative or false-positive diagnoses, due to morphological overlap or misleading clinical and radiological contexts. For instance, pauci-cellular lesions, such as lobular carcinomas, often lead to false-negative diagnoses, whereas complex sclerosing lesions, fibroadenomas, and papillary lesions may show concerning features, resulting in a false positive. The same is true for some benign inflammatory pathologies, such as steatonecrosis, and uncommon lesions, such as collagenous spherulosis. Ductal carcinoma in situ can lead to both false-negative and false-positive diagnoses, and high-grade lesions are impossible to tell apart from invasive carcinomas. These are discussed in detail. Procedural and preanalytical conditions, and the role of ancillary testing, are also briefly addressed. Key Messages: Breast FNAB is a powerful diagnostic technique, fast and minimally invasive. Even in contexts which lack expertise, this technique can be successfully adopted with a cautious approach and as long as pitfalls are kept in mind, benefiting patients and healthcare systems. © 2024 S. Karger AG, Basel.

© 2024 S. Karger AG, Basel.

Keywords

• Biopsy, Fine-Needle; Breast; Breast Neoplasms; Cytodiagnosis; Cytology; Diagnosis, Differential; Diagnostic Errors; False Negative Reactions; False Positive Reactions; Female; Humans; Predictive Value of Tests; Reproducibility of Results; aged; breast lesion; cytology; cytopathology; diagnosis; ductal breast carcinoma in situ; false negative result; false positive result; fat necrosis; fibroadenoma; fine needle aspiration biopsy; human; human tissue; invasive carcinoma; large core needle biopsy; lobular carcinoma; needle biopsy; review; breast; breast tumor; cytodiagnosis; cytology; diagnostic error; differential diagnosis; female; fine needle aspiration biopsy; pathology; predictive value; prevention and control; procedures; reproducibility