1 / 116

FNA of BREAST The 6 th Arab-British School of Pathology

FNA of BREAST The 6 th Arab-British School of Pathology. Nina S Shabb, M.D. American University of Beirut Medical center, Beirut Lebanon. Objectives. Overview of breast FNA AUBMC data 2003-200 CNB vs FNA of palpable and non palpable lesions. Status of breast FNA. 1930: Introduced

chinara
Télécharger la présentation

FNA of BREAST The 6 th Arab-British School of Pathology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. FNA of BREASTThe 6th Arab-British School of Pathology Nina S Shabb, M.D. American University of Beirut Medical center, Beirut Lebanon

  2. Objectives • Overview of breast FNA • AUBMC data 2003-200 • CNB vs FNA of palpable and non palpable lesions

  3. Status of breast FNA • 1930: Introduced • 1980-90: ↑ ↑ ↑ • Late 90’s-now: ↓ • Non palpable masses: Replaced CNB • Palpable masses: CNB = FNA ? (institution dependent)

  4. Reasons for ↓ popularity • Lack of experienced cytopathologists • ↑ Diagnostic errors • ↑ Insufficient samples • False positives • False negatives • Medico legal issues • Inability to distinguish In situ from invasive carcinoma

  5. Trend of FNA of breast at AUBMC Total number: 1794

  6. AUBMC data • All breast FNAs with corresponding surgical pathology material were reviewed over 5 years (Jan 2003 - Dec 2007) • FNA reports were categorized C1-C5 • Palpable and non palpable masses were segregated • Data analyzed

  7. Diagnostic categories • C1: Unsatisfactory • C2: Benign lesion • C3: Atypical, probably benign • C4: Suspicious for malignancy • C5: Malignant The uniform approach to breast FNA. NCI recommendations

  8. “Triple test” • FNA results • Clinical findings • Radiologic findings Combining these 3 tests improves false negative and false positive results

  9. FNA/Pathology correlation, AUBMC,2003-2007 FN: 6. FP: 1. Unsatisfactory:5%

  10. Who should perform the FNA? • The person who is going to read it! (pathologist adequately trained) • Gleans information from gross findings and feel of the needle • Less unsatisfactory results (multiple passes as needed) • Less interpretative errors • Highest sensitivity and specificity

  11. Complications of FNA • Very rare • Pain • Bleeding/hematoma: Pressure • Infection: Proper cleaning • Pneumothorax: Tangential aspirate • Vasovagal reaction: Legs up • Needle tract seeding? No

  12. C1 Unsatisfactory

  13. FNA/Pathology correlation, AUBMC,2003-2007 C1: 5%

  14. C1 palpable vs non palpable C1: 3.5% (2.3%pos) C1: 8%

  15. C1 (Unsatisfactory) • When FNA does not explain the mass • Lesions responsible for C1 • Small • Fibrotic • Hypocellular benign and malignant • Operator dependent • Range in literature: 0.7-47% (5%) • CNB: advantage

  16. C1 • Management: More tissue

  17. C2 Benign

  18. C2 benign • FNA: Adequate and representative material of benign disease • FCC (cysts) • Abscess • Fat necrosis • Fibroadenoma • Other

  19. FNA/Pathology correlation, AUBMC,2003-2007 FN: 1

  20. FNA/pathology correlation of palpable masses

  21. FNA/pathology correlation of non palpable masses

  22. C2 (benign) • 1 False negative: (1%) DCIS Cribriform and micropapillary. Misinterpreted on FNA as FCC

  23. FCC • Cyst content: Clear, few macrophages • Hypocellular • Benign duct epithelial cells • Naked nuclei • Apocrine metaplastic cells

  24. Fibroadenoma • Pigeon egg, rubbery feel • Smears (pattern recognition) • Very cellular • 3 components • Staghorn epithelial cohesive honeycombed duct cells • Stromal fragments • Numerous myoepithelial cells (naked bipolar nuclei)

  25. C2 (Benign) • Negative triplet: Follow up • FNA: Benign • Clinical: Benign • Radiologic: Benign

  26. C5 Malignant

  27. C5 Malignant • Primary • IDC nos • ILC • Mucinous • Tubular • Papillary • Other • Metastatic • Hematopoetic

  28. FNA/Pathology correlation, AUBMC,2003-2007 False positive: Adenomyoepithelioma

  29. FNA/pathology correlation of palpable masses

  30. FNA/pathology correlation of non palpable masses

More Related