The Role of Cytology and Biopsy in the Investigation of Breast Disease Flashcards
how can microscopic examination of a thin layer of cells on a slide be obtained
Fine Needle Aspiration
Direct smear from nipple discharge
Scrape of nipple with scalpel
what is the role of cytology (breast cancer)
Symptomatic Clinic
“Triple assessment” of patient by surgeon, radiologist and cytopathologist
Sample of main lesion or FNA of axillary node/satellite lesions
what would be examples of symptomatic breast cancer
Discrete mass
Cystic - fluid
Solid
Diffuse thickening
what equipment is needed for FNA technique
23G needle
10ml syringe +/- Cameco holder
Alcohol swab
Cotton wool, sticking plaster
Glass slides, pencil
+/-Vial with saline for needle washings
what should be done to ensure good FNA technique
Ensure patient is comfortable
Examine to locate lump
Swab area
Localise lump between fingers
Patient
Informed of procedure
Comfort
Chaperone
Safety
Appropriate PPE
Dispose of needle
Care handling fresh material/ infection risk
what is the procedure for FNA technique
Insert needle (45o)
Aspirate using in and out action applying negative pressure on syringe
Release pressure and remove needle
(also “non- suction aspiration technique”)
when is US guided FNA done
when there is an impalpable area seen on US
what would a benign lump show cytologically
low/ moderate cellularity
cohesive groups of cells
flat sheets of cells
Bare oval (bipolar) nuclei in background
cells of uniform size
uniform chromatin pattern
what would be seen in a malignant lump cytologically
high cellularity
crowding/overlapping of cells
loss of cohesion
nuclear pleomorphism
hyperchromasia
absence of bipolar nuclei
is cytology diagnosis specific
Usually diagnosis non specific ie. adenocarcinoma NOS. Occasionally features may suggest type
eg lobular or tubular carcinoma
what is the cytology scoring system
C1 Unsatisfactory/ Insufficient cells for diagnosis
C2 Benign
C3 Atypia (probably benign)
C4 Suspicious (probably malignant)
C5 Malignant
how are cysts managed
Aspiration is curative
Fluid discarded unless
fluid is bloodstained
there is residual mass
advantage of FNA
Simple procedure - can be done at clinic
Well tolerated by patients
Inexpensive
Immediate results
limitations FNA
False Negatives
False Positives
Invasion cannot be assessed
Grading cannot be done
not 100% accurate
what can be complications of FNA
Pain
Haematoma
Fainting
Infection, Pneumothorax –rare
