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

IF 1.6 4区 医学 Q3 PATHOLOGY
Acta Cytologica Pub Date : 2024-01-01 Epub Date: 2024-06-11 DOI:10.1159/000539692
Daniel Gomes Pinto, Fernando C Schmitt
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引用次数: 0

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.

克服乳腺 FNAC 的误区:实用综述。
背景:细针穿刺细胞学检查(FNAC)是初步评估乳腺病变的基础技术,为细胞学评估提供了快速、微创的选择。虽然 FNAC 可以避免进行核心针活检 (CNB),但技术上的差异、主观解释和固有的局限性给诊断带来了挑战。国际细胞学学会(IAC)建立了横滨系统,并正在与 IARC 联合开发世界卫生组织乳腺细胞病理学报告系统,以统一诊断标准,提高诊断的精确性和一致性。摘要:本综述评估了乳腺细胞病理学的常见误区。由于形态学重叠或误导临床和放射学背景,这些常见和不常见的实体很容易导致假阴性或假阳性诊断。例如,小叶癌等低细胞性病变常导致假阴性诊断,而复杂硬化性病变、纤维腺瘤和乳头状病变则可能显示相关特征,从而导致假阳性诊断。一些良性炎症病变(如脂肪变性)和不常见的病变(如胶原性球形病变)也是如此。乳腺导管原位癌(DCIS)可导致假阴性和假阳性诊断,而高级别病变则无法与浸润性癌区分开来。下文将详细讨论这些问题。此外,还简要讨论了程序和分析前条件以及辅助检查的作用:乳腺 FNAB 是一种强大的诊断技术,具有快速和微创的特点。即使在缺乏专业知识的情况下,只要采取谨慎的方法并牢记隐患,也能成功采用这种技术,从而使患者和医疗系统受益。
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来源期刊
Acta Cytologica
Acta Cytologica 生物-病理学
CiteScore
3.70
自引率
11.10%
发文量
46
审稿时长
4-8 weeks
期刊介绍: With articles offering an excellent balance between clinical cytology and cytopathology, ''Acta Cytologica'' fosters the understanding of the pathogenetic mechanisms behind cytomorphology and thus facilitates the translation of frontline research into clinical practice. As the official journal of the International Academy of Cytology and affiliated to over 50 national cytology societies around the world, ''Acta Cytologica'' evaluates new and existing diagnostic applications of scientific advances as well as their clinical correlations. Original papers, review articles, meta-analyses, novel insights from clinical practice, and letters to the editor cover topics from diagnostic cytopathology, gynecologic and non-gynecologic cytopathology to fine needle aspiration, molecular techniques and their diagnostic applications. As the perfect reference for practical use, ''Acta Cytologica'' addresses a multidisciplinary audience practicing clinical cytopathology, cell biology, oncology, interventional radiology, otorhinolaryngology, gastroenterology, urology, pulmonology and preventive medicine.
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