Breast fine needle aspiration continues to be relevant in a large academic medical center: experience from Massachusetts General Hospital

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Eric James
7 years ago
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1 Breast fine needle aspiration continues to be relevant in a large academic medical center: experience from Massachusetts General Hospital Elena Brachtel, M.D. Department of Pathology Massachusetts General Hospital Harvard Medical School Boston, MA, USA

3 E. Brachtel Breast Cancer Res Treat 2016 Breast cytology replaced by core biopsy at many medical centers Continuously performed at MGH Retrospective analysis (N=1654) Comparison of cytologic with histologic diagnoses; ER, PR & HER2 testing Included 300 cell blocks (128 malignant)

4 E. Brachtel Breast Cancer Res Treat 2016 Figure 1: Ductal Carcinoma Case #1403 Papanicolaou-stained direct smear (a) cell block (b) and HER2 FISH (c)

5 Ductal Carcinoma Case #1403 cell block (Fig 1b)

6 Ductal Carcinoma Case #1403 HER2 FISH amplified (Fig 1c)

7 E. Brachtel Breast Cancer Res Treat 2016 Figure 2: Breast Cytology Diagnoses

8 E. Brachtel Breast Cancer Res Treat 2016 Surgical Pathology Diagnosis Cytology Diagnosis Benign (%) Atypical (%) Malignant (%) Total (%) Non-diagnostic 65 (82.3) 1 (1.3) 13 (16.5) 79 (100) Benign 1133 (95.8) 21 (1.8) 29 (2.5) 1183 (100) Atypical 34 (39.0) 18 (20.7) 35 (40.2) 87 (100) Suspicious 2 (6.7) 0 (0) 28 (93.3) 30 (100) Malignant 0 (0) 0 (0) 275 (100) 275 (100) Total 1234 (74.6) 40 (2.4) 380 (23.0) 1654 (100) Table 1: Breast Cytology & Surgical Path Diagnoses

9 E. Brachtel Breast Cancer Res Treat 2016 Overall % Primary breast % Breast reconstruction, chest wall % Parameters N=1654 N=1602 N=52 Non-diagnostic rate Indeterminate rate Absolute sensitivity Complete sensitivity Specificity PPV of malignant PPV of suspicious NPV of benign NPV of atypical False positive rate False negative rate Table 2: Breast Cytology Diagnostic Accuracy

10 E. Brachtel Breast Cancer Res Treat 2016 Tissue block IHC Concordance Cell block IHC Positive Negative Total Rate Kappa P value ER 98.2% <0.001 Positive Negative Total PR 100% <0.001 Positive Negative Total Table 3: ER and PR Diagnostic Concordance

11 E. Brachtel Breast Cancer Res Treat 2016 HER-2 Tissue block IHC Cell block IHC 0/ Total Concordance Rate Kappa P value 0/ Total % <0.001 HER-2 Tissue block FISH Cell block FISH Amplified Not amplified Total Concordance Rate Kappa P value Amplified Not amplified Total % <0.001 Table 4: HER2 Diagnostic Concordance

12 E. Brachtel Breast Cancer Res Treat 2016 Figure S1: Suspicious Cytology > Radial Scar

13 E. Brachtel Breast Cytology False-negative Pitfall: Lobular carcinoma

14 E. Brachtel Breast Cytology False-negative Pitfall: Well-differentiated ductal carcinoma

15 E. Brachtel Breast Cytology Minimally Invasive FNA for Diagnosis in Inoperable Patients

16 E. Brachtel Breast Cytology FNA Confirmation for Likely Benign Breast Lesions

17 E. Brachtel Breast Cancer Res Treat 2016 Breast cytology high sensitivity and specificity CAUTION: FALSE NEGATIVE CYTOLOGY Sampling more an issue than interpretation Lobular carcinoma continues to be difficult ER, PR and HER2 testing on (well prepared) cell blocks highly concordant with surgical pathology Breast FNA especially useful for diagnosis & receptors in inoperable elderly patients, pregnant patients, when immediate diagnosis is needed, in anticoagulated patients, for confirmation of likely benign lesions

18 Thank You For Your Attention Vielen Dank für Ihre Aufmerksamkeit

Nicole Kounalakis, MD

Breast Disease: Diagnosis and Management Nicole Kounalakis, MD Assistant Professor of Surgery Goal of Breast Evaluation The goal of breast evaluation is to classify findings as: normal physiologic variations