Imprint cytology from ultrasound-guided core biopsies: accurate and immediate diagnosis in a one-stop breast clinic
Introduction
One-stop breast clinics provide triple assessment of symptomatic breasts, using clinical examination, imaging and pathological analysis, all at the same hospital visit. The use of fine-needle aspiration cytology (FNAC) and the availability of immediate reporting by radiologists and cytopathologists has made it possible to give patients their results on the same day. FNAC is very operator dependent, both for the person acquiring the sample and the person reporting the specimen. It also has a relatively high inadequacy rate for cancers. In the current literature there are debates about the relative merits of FNAC and core biopsy.1., 2., 3., 4. Core biopsy as a technique used nationally gives better sensitivity and specificity than FNAC.3 It also provides information on grade of tumour and receptor status. However, histological analysis of a core biopsy takes too long to allow for same-day diagnosis.
Imprints taken from core biopsy specimens can provide material for immediate cytological analysis.5., 6., 7., 8. We hoped this technique could combine the potential to offer our patients same-day diagnosis with enhanced sensitivity and specificity and the additional information provided by core biopsy. We introduced the technique into our one-stop breast clinic and audited the results.
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Materials and methods
One hundred and eleven ultrasound-guided core biopsies, consecutively acquired by one of two radiologists with an interest in breast imaging, were included in the study. Data was collected prospectively. The biopsies were taken from 107 patients, all women with a mean age of 55 years (SD±16 years). There were two separate masses within one breast in three patients, and a mass in each breast in one patient. Ninety-seven biopsies were from symptomatic breasts and 14 from screen-detected
Results
Forty-two benign and 69 malignant lesions were biopsied. The pathologies of the breast lesions are listed in Table 1. This represents the histology of the surgical specimen if surgery was performed, and of the core biopsy if not.
Of the patients with 42 benign lesions, eight underwent surgery (the final diagnoses being two complex sclerosing lesions, two intra-duct papillomas and four fibroadenomas). The diagnosis of six of these lesions was known before surgery. Both of the other masses were
Discussion
The imprint cytology results in this study fulfil the minimum requirements of the NHSBSP in every parameter and exceed the “preferred” levels set out by the NHSBSP for all parameters other than “suspicious” rate. A high “suspicious” rate is arguably less important for imprint cytology, where a core biopsy has also already been obtained, than for FNAC when it implies that the patient will require a second invasive test. In the case of imprint cytology, the implication is that diagnosis is
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