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
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) 2009-2015 Comparison of cytologic with histologic diagnoses; ER, PR & HER2 testing Included 300 cell blocks (128 malignant)
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)
Ductal Carcinoma Case #1403 cell block (Fig 1b)
Ductal Carcinoma Case #1403 HER2 FISH amplified (Fig 1c)
E. Brachtel Breast Cancer Res Treat 2016 Figure 2: Breast Cytology Diagnoses
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
E. Brachtel Breast Cancer Res Treat 2016 Overall % Primary breast % Breast reconstruction, chest wall % Parameters N=1654 N=1602 N=52 Non-diagnostic rate 4.8 4.7 5.8 Indeterminate rate 7.1 7.3 0 Absolute sensitivity 74.5 74.4 83.3 Complete sensitivity 91.6 91.7 83.3 Specificity 95.5 95.4 100 PPV of malignant 100 100 100 PPV of suspicious 93.3 93.3 - NPV of benign 97.5 97.6 97.7 NPV of atypical 59.8 59.8 - False positive rate 0 0 0 False negative rate 7.9 7.8 16.7 Table 2: Breast Cytology Diagnostic Accuracy
E. Brachtel Breast Cancer Res Treat 2016 Tissue block IHC Concordance Cell block IHC Positive Negative Total Rate Kappa P value ER 98.2% 0.951 <0.001 Positive 43 0 43 Negative 1 13 14 Total 44 13 57 PR 100% 1.000 <0.001 Positive 32 0 32 Negative 0 23 23 Total 32 23 55 Table 3: ER and PR Diagnostic Concordance
E. Brachtel Breast Cancer Res Treat 2016 HER-2 Tissue block IHC Cell block IHC 0/1+ 2+ 3+ Total Concordance Rate Kappa P value 0/1+ 32 4 1 37 2+ 4 18 1 23 3+ 0 1 4 5 Total 36 23 6 65 83.1% 0.694 <0.001 HER-2 Tissue block FISH Cell block FISH Amplified Not amplified Total Concordance Rate Kappa P value Amplified 7 0 7 Not amplified 3 36 39 Total 10 36 46 93.5% 0.785 <0.001 Table 4: HER2 Diagnostic Concordance
E. Brachtel Breast Cancer Res Treat 2016 Figure S1: Suspicious Cytology > Radial Scar
E. Brachtel Breast Cytology False-negative Pitfall: Lobular carcinoma
E. Brachtel Breast Cytology False-negative Pitfall: Well-differentiated ductal carcinoma
E. Brachtel Breast Cytology Minimally Invasive FNA for Diagnosis in Inoperable Patients
E. Brachtel Breast Cytology FNA Confirmation for Likely Benign Breast Lesions
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
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