Concluding Remarks.

Abstract

nostics is the possibility of performing the biomolecular analyses for the preoperative characterization of large tumors, which can benefit in some cases from neoadjuvant treatments. Recently, new recommendations propose to definitively abandon FNAC, restricting all morphological investigations to CNB [Willems et al., 2012]. But is this true? Has FNAC completely lost its role, allowing us to remove it from the routine diagnostic practice? After carefully reading the contemporary literature, it is evident that to this day FNAC maintains a role as first-level examination in all the centers where cytopathologists grant their constant presence in the radiology units: they take actively part in the sampling sessions, provide a clear and standardized report, including diagnostic categories, and integrate their diagnoses in the context of a multidisciplinary team [Berner et al., 2003; Brancato et al., 2012; Delaloge et al., 2016; Kocijan et al., 2008; Mitra and Dey, 2016]. This allows eventually completing the morphological diagnosis with ancillary techniques, when truly necessary, by resorting to further sampling. Moreover, this close collaboration between radiologist and pathologist leads to a better evaluation of the individual situation, and they decide together whether to extend the examination on multiple lesions and axillary lymph nodes, and eventually resort directly to CNB, if needed. Fine-needle aspiration cytology (FNAC) has traditionally been regarded as the simplest, less invasive, and less expensive diagnostic procedure for the definition of breast lesions [Khemka et al. 2009; Saha et al. 2016; Wang et al., 2017]. In expert hands, it allows obtaining an accurate diagnosis in most breast lesions. The introduction of widespread mammographic screening programs and the consequent detection of a large number of small, nonpalpable lesions have increasingly established the routine use of other minimally invasive biopsy methods using heavier gauge cutting needles – core needle biopsies (CNBs) and other automatic, imaging-guided devices, such as vacuum-assisted biopsies – partially obscuring the central role of FNA [Brancato et al., 2012; Tabbara et al., 2000]. These new opportunities lead to a greater autonomy of the radiologists, who do not feel anymore the need of having the on-site cytopathologist attending the sampling session. Indeed, this professional is not always available in the “spoke” health care centers, although it is an indispensable element for the rapid on-site evaluation of sample adequacy and the “fast-track” diagnostic process. For this reason, CNB, previously considered as a secondlevel examination, available in cases with inadequate (C1) or indeterminate (C3–C4) cytology, has increasingly been used as a primary diagnostic method without resorting to cytology. Another reason for the spread of CNB in breast diag-