title: The role of breast FNAC in diagnosis and clinical management: a survey of current practice.
abstract: Most participating countries have now adopted a triple assessment approach, i.e. clinical,imaging and pathology, to breast diagnosis, with FNAC as the first-line pathological investigation in both screening and symptomatic populations, with the exception of microcalcifications. Pathologists specialized in cytopathology are best qualified to collect and interpret FNAC samples, but this is not always possible or practical. Radiologists involved in breast imaging should ensure that they have the necessary skills to carry out FNAC under all forms of image guidance. Best results are achieved by a combination of both techniques, as shown in the image-guided FNAC in the presence of the cytopathologist. The majority of European countries use similar reporting systems for breast FNAC (C1-C5), in keeping with European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis, although some still prefer descriptive reporting only. When triple assessment is concordant, final treatment may proceed on the basis of FNAC, without a tissue biopsy. ER and PR assessment can be done safely on FNAC material. However, not all institutions may have expertise in doing this. HER-2 protein expression on direct cytological preparations is insufficiently reliable for clinical use, although its use for FISH is possible, if expertise is available. The majority of participants practise a degree of one-stop diagnosis with a cytopathologist present in the out-patient clinic. Formal recognition of the importance of the time spent outside the laboratory, both for cytopathologist and cytotechnologist, is necessary in order to ensure appropriate resourcing. The use of core biopsy (CB) has increased, although not always for evidence-based reasons. CB and FNAC are not mutually exclusive. FNAC should be used in diagnosis of benign, symptomatic lesions and CB in microcalcifications, suspicious FNAC findings and malignancies where radiology cannot guarantee stromal invasion.
authors.affiliation: Department of Histopathology, University College London, London, UK. g.kocjan@ucl.ac.uk
authors.forename: G
authors.initials: G
authors.lastname: Kocjan
authors.forename: C
authors.initials: C
authors.lastname: Bourgain
authors.forename: A
authors.initials: A
authors.lastname: Fassina
authors.forename: B
authors.initials: B
authors.lastname: Hagmar
authors.forename: A
authors.initials: A
authors.lastname: Herbert
authors.forename: K
authors.initials: K
authors.lastname: Kapila
authors.forename: I
authors.initials: I
authors.lastname: Kardum-Skelin
authors.forename: V
authors.initials: V
authors.lastname: Kloboves-Prevodnik
authors.forename: S
authors.initials: S
authors.lastname: Krishnamurthy
authors.forename: H
authors.initials: H
authors.lastname: Koutselini
authors.forename: B
authors.initials: B
authors.lastname: Majak
authors.forename: W
authors.initials: W
authors.lastname: Olszewski
authors.forename: B
authors.initials: B
authors.lastname: Onal
authors.forename: Z
authors.initials: Z
authors.lastname: Pohar-Marinsek
authors.forename: I
authors.initials: I
authors.lastname: Shabalova
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.forename: E
authors.initials: E
authors.lastname: Tani
authors.forename: P
authors.initials: P
authors.lastname: Vielh
authors.forename: H
authors.initials: H
authors.lastname: Wiener
authors.forename: U
authors.initials: U
authors.lastname: Schenck
authors.forename: F
authors.initials: F
authors.lastname: Schmitt
mesh_terms: D044963:Biopsy, Fine-Needle / Q000592:standards / Q000706:statistics & numerical data; D001940:Breast / Q000473:pathology*; D001941:Breast Diseases / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human