Objective: We investigated the role and turn around time of rapid staining and immediate interpretation of fine-needle aspiration cytology (FNAC) for women with palpable breast lesions. Study Design: A total of 408 FNAC specimens from 400 patients with palpable breast lesions was analyzed for immediate interpretation and preliminary cytologic diagnosis. All cytological diagnoses were correlated with subsequent alcohol-fixed Papanicolaou-stained slides, mammographic, ultrasonographic and histopathological findings. Results: Of the 408 specimens, 243 (59.6%) were interpreted as benign, 37 (9.0%) atypical, 22 (5.4%) suspicious, 68 (16.7%) malignant, and 38 (9.3%) unsatisfactory. 132 of 408 (32.4%) had subsequent surgical procedures; the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 88.5, 100, 100, 81.9 and 92.4%, respectively. The average turn around time was 8.6 min. Mammographic results were available in 242 (59.3%) cases, with 112 (46.3%) undergoing surgical excision. In correlation with mammography and surgical pathology, the false-positive rate, false-negative rate, sensitivity, specificity and accuracy were 1.9, 10.5, 98.1, 89.5 and 95.8%, respectively. Conclusions: Rapid FNAC interpretation is a useful, effective diagnostic method for palpable breast lesions in our healthcare environment.

Keywords:
Immediate interpretation, Mammography, Rapid staining, Ultrasonography, Breast, Diagnostic accuracy, Fine-needle aspiration cytology, Histopathology
1.
Bassett LW, Jackson VP, Fu KL, Fu Y-S: Diagnosis of Diseases of the Breast, ed 2. Amsterdam, Elsevier Saunders, 2005, pp 519–523.
2.
Rosa M: Fine-needle aspiration biopsy: a historical overview. Diagn Cytopathol 2008;36:773–775.
3.
Feoli F, Paesmans M, Eeckhout PV: Fine needle aspiration cytology of the breast: impact of experience on accuracy, using standardized cytologic criteria. Acta Cytol 2008;52:145–151.
4.
Choi YD, Choi YH, Lee J-H, et al: Analysis of fine needle aspiration cytology of the breast: a review of 1,297 cases and correlation with histologic diagnoses. Acta Cytol 2004;48:801–806.
5.
Ljung B-M, Drejet A, Chiampi N, et al: Diagnostic accuracy of fine-needle aspiration biopsy is determined by physician training in sampling technique. Cancer Cytopathology 2001;93:263–268.
6.
Kerlikowske K, Smith-Bindman R, Ljung B-M, Grady D: Evaluation of abnormal mammography results and palpable breast abnormalities. Ann Intern Med 2003;139:274–284.
7.
Chaiwun B, Settakorn J, Ya-in C, et al: Effectiveness of fine-needle aspiration cytology of breast: analysis of 2,375 cases from Northern Thailand. Diagn Cytopathol 2002;26:201–205.
8.
Chang MC, Ho WL: The immediate interpretation for fine-needle aspiration cytology. Zhonghua Yi Xue Za Zhi (Chinese Medical Journal Taipei) 1993;52:325–331.
9.
Civardi G, Fornari F, Cavanna L, et al: Value of rapid staining and assessment of ultrasound-guided fine needle aspiration biopsies. Acta Cytol 1998;32:552–554.
10.
Nasuti JF, Gupta PK, Baloch ZW: Diagnostic value and cost-effectiveness of on-site evaluation of fine-needle aspiration specimens: review of 5,688 cases. Diagn Cytopathol 2002;27:1–4.
11.
Wells CA, Ellis IO, Zakhour HD, Wilson AR and the Cytology Subgroup of the National Co-ordinating Committee for Breast Cancer Screening Pathology: Guidelines for cytology procedures and reporting on fine needle aspirates of the breast. Cytopathology 1994;5:316–334.
12.
NHSBSP: Guidelines for Non-Operative Diagnostic Procedures and Reporting in Breast Cancer Screening. NHSBSP publication No. 50. Sheffield, NHSBSP, 2000.
13.
Boerner S, Fornage B, Singletary E, Sneige N: Ultrasound-guided fine-needle aspiration (FNA) of nonpalpable breast lesions: a review of 1,885 FNA cases using the National Cancer Institute-supported recommendations on the uniform approach to breast FNA. Cancer 1999;25:19–24.
14.
Silverman JF, Finley JL, O’Brien KF, et al: Diagnostic accuracy and role of immediate interpretation of fine needle aspiration biopsy specimens from various sites. Acta Cytol 1989;33:791–796.
15.
Layfield LJ, Bentz JS, Gopez EV: Immediate on-site interpretation of fine-needle aspiration smears: a cost and compensation analysis. Cancer (Cancer Cytopathology) 2001;93:319–322.
16.
Joseph L, Edwards JM, Nicholson CM, Pitt MA, Howat AJ: An audit of the accuracy of fine needle aspiration using a liquid-based cytology system in the setting of a rapid access breast clinic. Cytopathology 2002;13:343–349.
17.
Ariga R, Bloom K, Reddy VB, et al: Fine-needle aspiration of clinically suspicious palpable breast masses with histopathologic correlation. Am J Surg 2002;184:410–413.
18.
Wells CA, Perera R, White FE, Domizio P: Fine needle aspiration cytology in the UK breast screening programme: a national audit of results. Breast 1999;8:261–266.
19.
Orell SR, Miliauskas J: Fine needle biopsy cytology of breast lesions: a review of interpretative difficulties. Adv Anat Pathol 2005;12:233–245.
20.
Renshaw AA, Dean BR, Cibas ES: Receiver operating characteristics curves for analysis of the results of cervicovaginal smears: a useful quality improvement tool. Arch Pathol Lab Med 1997;121:968–975.
21.
Raab SS, Thomas PA, Lenel JC, et al: Pathology and probability: likelihood ratios and receiver operating characteristic curves in the interpretation of bronchial brush specimens. Am J Clin Pathol 1995;103:588–593.
22.
Yang GC: Ultrafast Papanicolaou stain is not limited to rapid assessments: application to permanent fine-needle aspiration smears. Diag Cytopathol 1995;13:160–162.
23.
Yang GCH, Alvarez II: Ultrafast Papanicolaou stain: an alternative preparation for fine-needle aspiration cytology. Acta Cytol 1995;39:55–60.
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