title: Breast fine-needle aspiration cytology performance in the high-risk screening population: a study of BRCA1/BRCA2 mutation carriers.
abstract: BACKGROUND
  The diagnosis of breast lesions is usually confirmed by fine-needle aspiration cytology (FNAC) or histological biopsy. Although there is increasing literature regarding the advantages and limitations of both modalities, there is no literature regarding the accuracy of these modalities for diagnosing breast lesions in high-risk patients, who usually have lesions detected by screening. The objective of the current study was to evaluate diagnostic performance indices of FNAC in breast cancer susceptibility gene (BRCA) mutation carriers.
  
  
  METHODS
  BRCA1/BRCA2 mutation carriers who underwent FNAC were selected from the database of the Rotterdam Family Cancer Clinic. FNAC accuracy parameters were calculated by taking the outcome of a subsequent histological diagnosis or clinical follow-up as reference standard.
  
  
  RESULTS
  In total, 320 FNACs were obtained, and FNAC examination was followed by histological examination in 150 patients. The rate of insufficient material was 25.6%. Sensitivity was 92.3%, specificity 96.3%. The false-positive rate was 3.7%, the false-negative rate was 7.7%, and accuracy was 94.7%. A substantial proportion of patients (35%) with malignant FNAC results underwent histological biopsy upfront surgical resection. Small lesion size (≤ 1 cm) and nonpalpability of the breast lesion were associated with decreased FNAC accuracy. In 113 patients who had a benign FNAC outcome without histological follow-up, no malignancies were detected during clinical or radiologic surveillance (median follow-up 84 months).
  
  
  CONCLUSIONS
  There is a role for FNAC in diagnosing breast lesions of BRCA1/BRCA2 mutation carriers, ie, to confirm a radiological (probably) benign lesion. However, despite the high overall sensitivity of FNAC, the authors recommend histological biopsy as the preferred diagnostic method for high-risk patients who have small or nonpalpable lesions.
authors.affiliation: Department of Pathology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Radka D
authors.initials: RD
authors.lastname: Georgieva
authors.forename: Inge M
authors.initials: IM
authors.lastname: Obdeijn
authors.forename: Agnes
authors.initials: A
authors.lastname: Jager
authors.forename: Maartje J
authors.initials: MJ
authors.lastname: Hooning
authors.forename: Madeleine M A
authors.initials: MM
authors.lastname: Tilanus-Linthorst
authors.forename: Carolien H M
authors.initials: CH
authors.lastname: van Deurzen
mesh_terms: D000328:Adult; D000368:Aged; D019313:BRCA1 Protein / Q000235:genetics*; D024682:BRCA2 Protein / Q000235:genetics*; D044963:Biopsy, Fine-Needle; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000235:genetics / Q000473:pathology*; D003581:Cytodiagnosis; D005260:Female; D006579:Heterozygote; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D009154:Mutation / Q000235:genetics*; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D055815:Young Adult
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human
keywords: BRCA; breast cancer; core-needle biopsy; fine-needle aspiration cytology