Objectives: To describe the pitfalls encountered in switching over from conventional smears (CSm) to liquid-based cytology (LBC). To explore modifications of our usual diagnostic criteria. Study Design: 190 ThinPrep breast samples with paired biopsies were retrospectively evaluated by two breast cytopathologists experienced only in CSm. They were again studied after LBC training. The diagnostic performances were compared. In additional calculations we included those C4/suspicious samples containing 70% high-grade nuclei and up to 30% nonmalignant cells in the C5/positive category, simulating that they harbored a malignant one-cell population. We prospectively validated this modification of our diagnostic criteria. Results: Training resulted in higher complete sensitivity: 94 versus 86% (p value 0.003) and lower false negative ratio: 4 versus 12% (p value 0.003). Training generated higher complete sensitivity than collaboration without training: 94 versus 89% (p value 0.008). In the simulation, the modified criteria increased absolute sensitivity to 74% with a 0.6% false positive rate. In the validation series, they generated up to 91% absolute sensitivity, 12% suspicious rate and no false negative and false positive diagnoses. Conclusion: Training in breast LBC may increase diagnostic performance. Samples containing 70% high-grade nuclei or more can be categorized as malignant.

1.
Feoli F, Paesmans M, Van Eeckhout P: Fine needle aspiration cytology of the breast: impact of experience on accuracy, using standardized cytological criteria. Acta Cytol 2008;52:145-151.
2.
Manfrin E, Mariotto R, Remo A, Reghellin D, Dalfior D, Falsirollo F, Bonetti F: Is there still a role for fine-needle aspiration cytology in breast cancer screening? Experience of the Verona Mammographic Breast Cancer Screening Program with real-time integrated radiopathologic activity (1999-2004). Cancer 2008;114:74-82.
3.
Wang HH, Ducatman BS: Fine needle aspiration of the breast. A probabilistic approach to diagnosis of carcinoma. Acta Cytol 1998;42:285-289.
4.
Tavassoli FA, Devilee P (eds): Tumours of the Breast and Female Genital Organs. Lyon, IARC Press, 2003.
5.
Gornstein B, Jacobs T, Bédard Y, Biscotti C, Ducatman B, Layfield L, McKee G, Sneige N, Wang H: Interobserver agreement of a probabilistic approach to reporting breast fine-needle aspirations on ThinPrep. Diagn Cytopathol 2004;30:389-395.
6.
Wells CA, Ellis IO, Zakhour HD, Wilson AR: Guidelines for cytology procedures and reporting on fine needle aspirates of the breast. Cytopathol 1994;5:316-334.
7.
Ali AS, Yin D, Yao D, Vazquez M: Criteria for the diagnosis of fibroepithelial lesions of the breast with liquid-based cytology. Acta Cytol 2004;48:481-486.
8.
El Hag IA, Aodah A, Kollur SM, Attallah A, Mohamed AA, Al-Hussaini H: Cytological clues in the distinction between phyllodes tumor and fibroadenoma. Cancer Cytopathol 2010;118:33-40.
9.
Lee KR, Papillo JL, St John T, Eyerer GJ: Evaluation of the ThinPrep processor for fine needle aspiration specimens. Acta Cytol. 1996;40:895-899.
10.
Biscotti CV, Shorie JH, Gramlich TL, Easley KA: ThinPrep vs. conventional smear cytologic preparations in analyzing fine-needle aspiration specimens from palpable breast masses. Diagn Cytopathol 1999;21:137-141.
11.
Dey P, Luthra UK, George J, Zuhairy F, George SS, Haji BI: Comparison of ThinPrep and conventional preparations on fine needle aspiration cytology material. Acta Cytol 2000;44:46-50.
12.
Michael CW, Hunter B: Interpretation of fine-needle aspirates processed by the ThinPrep technique: cytologic artifacts and diagnostic pitfalls. Diagn Cytopathol 2000;23:6-13.
13.
Kontzoglou K, Moulakakis KG, Konofaos P, Kyriazi M, Kyroudes A, Karakitsos P: The role of liquid-based cytology in the investigation of breast lesions using fine-needle aspiration: a cytohistopathological evaluation. J Surg Oncol 2005;89:75-78.
14.
Perez-Reyes N, Mulford DK, Rutkowski MA, Logan-Young W, Dawson AE: Breast fine-needle aspiration. A comparison of thin-layer and conventional preparation. Am J Clin Pathol 1994;102:349-353.
15.
Komatsu K, Nakanishi Y, Seki T, Yoshino A, Fuchinoue F, Amano S, Komatsu A, Sugitani M, Nemoto N: Application of liquid-based preparation to fine needle aspiration cytology in breast cancer. Acta Cytol 2008;52:591-596.
16.
Mygdakos N, Nikolaidou S, Tzilivaki A, Tamiolakis D: Liquid Based Preparation (LBP) cytology versus Conventional Cytology (CS) in FNA samples from breast, thyroid, salivary glands and soft tissues. Our experience in Crete (Greece). Rom J Morphol Embryol 2009;50:245-250.
17.
Veneti S, Daskalopoulou D, Zervoudis S, Papasotiriou E, Ioannidou-Mouzaka L: Liquid-based cytology in breast fine needle aspiration. Comparison with the conventional smear. Acta Cytol 2003;47:188-192.
18.
Frost JK: The Cell in Health and Disease. Basel, New York, S. Karger AG, 1969.
19.
Berner A, Davidson B, Sogstad E, Risberg B: Fine-needle aspiration cytology vs. core biopsy in the diagnosis of breast lesions. Diagn Cytopathol 2003;29:344-348.
20.
Florentine BD, Wu NC, Waliany S, Carriere C, Hindle W, Raza A: Fine needle aspiration (FNA) biopsy of palpable breast masses: comparison of conventional smears with the Cyto-Tek MonoPrep system. Cancer 1999;87:278-285.
21.
Bédard YC, Pollett AF: Breast fine-needle aspiration. A comparison of ThinPrep and conventional smears. Am J Clin Pathol 1999;111:523-527.
22.
Baum JK, Hanna LG, Acharyya S, Mahoney MC, Conant EF, Bassett LW, Pisano ED: Use of BI-RADS 3-probably benign category in the American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial. Radiology 2011;260:61-67.
23.
Ducatman BS, Wang HH: Breast; in Cibas ES, Ducatman BS: Cytology: Diagnostic Principles and Clinical Correlates. Philadelphia, Saunders, Elsevier, 2009, pp 221-254.
24.
Schmitt FC, Vielh P: Molecular biology and cytopathology. Principles and applications. Ann Pathol 2012;32:57-63.
25.
Uzan C, Andre F, Scott V, Laurent I, Azria E, Suciu V, Balleyguier C, Lacroix L, Delaloge S, Vielh P: Fine-needle aspiration for nucleic acid-based molecular analyses in breast cancer. Cancer 2009;117:32-39.
26.
Annaratone L, Marchiò C, Renzulli T, Castellano I, Cantarella D, Isella C, Macrì L, Mariscotti G, Balmativola D, Cantanna E, Deambrogio C, Pietribiasi F, Arisio R, Schmitt F, Medico E, Sapino A: High-throughput molecular analysis from leftover of fine needle aspiration cytology of mammographically detected breast cancer. Transl Oncol 2012;5:180-189.
27.
Perry N, Broeders M, de Wolf C, Törnberg S, Holland R, von Karsa L, Puthaar E (eds): European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis. Luxembourg, Office for Official Publications of the European Communities, 2006.
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