- Email: [email protected]
Comment on `Should Fine Needle Aspiration Cytology (FNAC) in Breast Assessment be Abandoned?'
863
CORRESPONDENCE
doi:10.1053/crad.2002.1090, available online at http://www.idealibrary.com on
doi:10.1053/crad.2002.1089, available online at http://www.idealibrary.com on
SHOULD FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) IN BREAST ASSESSMENT BE ABANDONED?
SIR, We acknowledge with respect the recent review article outlining the advantages and disadvantages of FNAC/Core biopsy in breast assessment [1]. However, we would like to make several comments. There is a clearly documented body of literature in support of large gauge core biopsy, and the increasing use of core biopsy has undoubtedly improved the pre operative diagnostic rate of breast cancer in the practice of breast screening. However, FNAC has a well established role, and has been shown, in good hands, to be highly sensitive and speci®c. While the bias of the literature continues to tend towards large gauge core biopsy only we risk losing an important diagnostic modality. During the year 2000±2001, 28% of screen detected cancers had C5 cytology with or without core biopsy. Figures for Scotland, show approx. 25% cancers are diagnosed using core biopsy alone, approx. 30% using cytology alone, and 30% use a combination of cytology and core biopsy [2]. (BASO). Therefore, 60% patients with cancer had the opportunity for an immediate diagnosis. The use of the FNAC as the sole cyto/histologic result is in¯uenced by local surgical practice. In this unit, it is our surgical practice to accept C5 cytology, with appropriate radiology and clinical ®ndings, to allow de®nitive treatment and axillary node procedure. Individual unit practice is also in¯uenced by clinic set up, geographical factors and cytologist availability. In this unit, the cytologist is available on site during the assessment process, allowing rapid input and contribution to the multidisciplinary case review. If immediate cytology reporting was consistently available, 60% of Scottish screen detected cancers would have a diagnosis on the day of the procedure. We are using large gauge core biopsy increasingly, as standard practice in the diagnosis of microcalci®cations, and following cytology, if that result has not yielded adequate information for de®nitive management. However, the advantages from FNAC of cost, speed of performance, sampling accuracy and immediate reporting should not be underestimated. A false negative core biopsy cannot be countered with cytology if this technique is no longer available. It is misleading to translate these conclusions directly into the symptomatic practice. Using core biopsy alone in symptomatic practice is time consuming and may be uneccessarily invasive. The author herself acknowledges that FNAC is a more suitable technique for the one stop clinic. We strongly concur with the conclusion that multidisciplinary assessment is essential for eective patient management but we would submit that FNAC is integral to that multidisciplinary assessment alongside the other diagnostic modalities and the choice of FNAC, Core biopsy, either alone or in combination should be made on an individual patient basis.
SIR, We were interested to read the above review article [1] on the utility of FNAC, but noticed that there was no mention of imprint cytology. Imprint cytology obtained from core biopsy samples can be used to provide an immediate cytological result and previous reports of its accuracy have been promising [2±4]. We are currently auditing the results of touch imprint cytology obtained from US guided core biopsy samples in the context of a one-stop triple assessment clinic. Preliminary results of our audit of core imprint cytology ( from the ®rst 28 patients) have given very promising results, with absolute sensitivity of over 90% and no false negative, false positive or inadequate results so far. Unlike FNAC, even if the immediate cytology from core imprint has inadequate cellularity is of uncertain cytology (C3 or C4), the core biopsy used to provide it may give the answer without the need for a further interventional procedure. Sampling error is reduced by performing the core biopsies under ultrasound guidance. The technique therefore combines several advantages of FNAC with those of core biopsy. We believe imprint cytology has the potential to provide an accurate diagnostic tool able to give same day results for counselling and planning purposes. L. JONES* M. LOTT C. CALDER E. KUTT
Avon Breast Screening Programme, Central Health Clinic, Tower Hill, Bristol BS2 0JD, U.K.
REFERENCES 1 Litherland JC. Should Fine Needle Aspiration Cytology (FNAC) in Breast Assessment Be Abandoned?. Clin Radiol 2001;57:81±84. 2 Newman MR, Frost FA, Sterrett GF, Bourke AG, Thompson RI, Hastrich DJ, Ingham DM. Diagnosis of breast microcalci®cations: a comparison of stereotactic FNA and core imprint cytology as adjuncts to core biopsy. Pathology 2001;33:449±453. 3 Albert US, Duda V, Hadji P, Goerke K, Hild F, Bock K, Ramaswamy A, Schulz KD. Imprint cytology of core needle biopsy specimens of breast lesions. A rapid approach to detecting malignancies with comparison of cytologic and histopathologic analyses of 173 cases. Acta Cytol 2000;44:57±62. 4 Jacobs TW, Silverman JF, Schroeder B, Raza S, Baum JK, Schmitt SJ. Accuracy of touch imprint cytology of image-directed breast core needle biopsies. Acta Cytol 1999;43:169±74.
A. M. GILCHRIST
Scottish Breast Screening Programme, 42 Ardmillan Terrace, Edinburgh, Scotland EH11 2JL, U.K.
REFERENCES 1 Litherland JC. Should Fine Needle Aspiration Cytology (FNAC) in breast assessment be abandoned? Glasgow Royal In®rmary and West of Scotland Breast Screening Programme, Glasgow, U.K. Clin Radiol 2002;57:81±84. 2 NHS Breast Screening Programme & British Association of Surgical Oncology Breast Group ``An Audit of Screen Detected Breast Cancers for the Year of Screening April 2000 to March 2001''.
CORRESPONDENCE
doi:10.1053/crad.2002.1090, available online at http://www.idealibrary.com on
doi:10.1053/crad.2002.1089, available online at http://www.idealibrary.com on
SHOULD FINE NEEDLE ASPIRATION CYTOLOGY (FNAC) IN BREAST ASSESSMENT BE ABANDONED?
SIR, We acknowledge with respect the recent review article outlining the advantages and disadvantages of FNAC/Core biopsy in breast assessment [1]. However, we would like to make several comments. There is a clearly documented body of literature in support of large gauge core biopsy, and the increasing use of core biopsy has undoubtedly improved the pre operative diagnostic rate of breast cancer in the practice of breast screening. However, FNAC has a well established role, and has been shown, in good hands, to be highly sensitive and speci®c. While the bias of the literature continues to tend towards large gauge core biopsy only we risk losing an important diagnostic modality. During the year 2000±2001, 28% of screen detected cancers had C5 cytology with or without core biopsy. Figures for Scotland, show approx. 25% cancers are diagnosed using core biopsy alone, approx. 30% using cytology alone, and 30% use a combination of cytology and core biopsy [2]. (BASO). Therefore, 60% patients with cancer had the opportunity for an immediate diagnosis. The use of the FNAC as the sole cyto/histologic result is in¯uenced by local surgical practice. In this unit, it is our surgical practice to accept C5 cytology, with appropriate radiology and clinical ®ndings, to allow de®nitive treatment and axillary node procedure. Individual unit practice is also in¯uenced by clinic set up, geographical factors and cytologist availability. In this unit, the cytologist is available on site during the assessment process, allowing rapid input and contribution to the multidisciplinary case review. If immediate cytology reporting was consistently available, 60% of Scottish screen detected cancers would have a diagnosis on the day of the procedure. We are using large gauge core biopsy increasingly, as standard practice in the diagnosis of microcalci®cations, and following cytology, if that result has not yielded adequate information for de®nitive management. However, the advantages from FNAC of cost, speed of performance, sampling accuracy and immediate reporting should not be underestimated. A false negative core biopsy cannot be countered with cytology if this technique is no longer available. It is misleading to translate these conclusions directly into the symptomatic practice. Using core biopsy alone in symptomatic practice is time consuming and may be uneccessarily invasive. The author herself acknowledges that FNAC is a more suitable technique for the one stop clinic. We strongly concur with the conclusion that multidisciplinary assessment is essential for eective patient management but we would submit that FNAC is integral to that multidisciplinary assessment alongside the other diagnostic modalities and the choice of FNAC, Core biopsy, either alone or in combination should be made on an individual patient basis.
SIR, We were interested to read the above review article [1] on the utility of FNAC, but noticed that there was no mention of imprint cytology. Imprint cytology obtained from core biopsy samples can be used to provide an immediate cytological result and previous reports of its accuracy have been promising [2±4]. We are currently auditing the results of touch imprint cytology obtained from US guided core biopsy samples in the context of a one-stop triple assessment clinic. Preliminary results of our audit of core imprint cytology ( from the ®rst 28 patients) have given very promising results, with absolute sensitivity of over 90% and no false negative, false positive or inadequate results so far. Unlike FNAC, even if the immediate cytology from core imprint has inadequate cellularity is of uncertain cytology (C3 or C4), the core biopsy used to provide it may give the answer without the need for a further interventional procedure. Sampling error is reduced by performing the core biopsies under ultrasound guidance. The technique therefore combines several advantages of FNAC with those of core biopsy. We believe imprint cytology has the potential to provide an accurate diagnostic tool able to give same day results for counselling and planning purposes. L. JONES* M. LOTT C. CALDER E. KUTT
Avon Breast Screening Programme, Central Health Clinic, Tower Hill, Bristol BS2 0JD, U.K.
REFERENCES 1 Litherland JC. Should Fine Needle Aspiration Cytology (FNAC) in Breast Assessment Be Abandoned?. Clin Radiol 2001;57:81±84. 2 Newman MR, Frost FA, Sterrett GF, Bourke AG, Thompson RI, Hastrich DJ, Ingham DM. Diagnosis of breast microcalci®cations: a comparison of stereotactic FNA and core imprint cytology as adjuncts to core biopsy. Pathology 2001;33:449±453. 3 Albert US, Duda V, Hadji P, Goerke K, Hild F, Bock K, Ramaswamy A, Schulz KD. Imprint cytology of core needle biopsy specimens of breast lesions. A rapid approach to detecting malignancies with comparison of cytologic and histopathologic analyses of 173 cases. Acta Cytol 2000;44:57±62. 4 Jacobs TW, Silverman JF, Schroeder B, Raza S, Baum JK, Schmitt SJ. Accuracy of touch imprint cytology of image-directed breast core needle biopsies. Acta Cytol 1999;43:169±74.
A. M. GILCHRIST
Scottish Breast Screening Programme, 42 Ardmillan Terrace, Edinburgh, Scotland EH11 2JL, U.K.
REFERENCES 1 Litherland JC. Should Fine Needle Aspiration Cytology (FNAC) in breast assessment be abandoned? Glasgow Royal In®rmary and West of Scotland Breast Screening Programme, Glasgow, U.K. Clin Radiol 2002;57:81±84. 2 NHS Breast Screening Programme & British Association of Surgical Oncology Breast Group ``An Audit of Screen Detected Breast Cancers for the Year of Screening April 2000 to March 2001''.