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[267] Efficient Cell Blocks Appear Improve Diagnosis of Ultrasound-Guided FNAs of Non-Cystic Breast Lesions without a Need for On-Site Adequacy Evaluation

A Akalin, D Lu, D Eaton, E Iuanow, A Larkin, A Fischer. UMass Memorial Medical Center, Worcester, MA

Background: Cell blocks provide diagnostic architectural information that complements smears or monolayers. On-site evaluation (OSE) of breast FNAs makes the on-site assessed material unavailable for a cell block. We previously found that a new rapid cell block technique is highly efficient at recovering sparse material, and improves diagnosis by frequently permitting diagnosis of invasion in FNAs of breast cancers or allowing accurate histologic grading of proliferative lesions. We tested the hypothesis that one monolayer slide and a rapid cell block without OSE would outperform OSE with multiple smears and a conventional cell block for ultrasound-guided breast FNAs.
Design: Due to relocation of Pathology in October 2005, we stopped performing OSE for breast FNAs. Instead, the same mammographers performed two passes, with additional passes if needle rinses showed no particles in the needle rinse. Rapid cell blocks were made after a ThinPrep. We examined the outcome of 134 consecutive non-cyst FNAs without OSE from October 2005 to April 2006, and compared them to 119 consecutive non-cyst FNAs from 2004 that had OSE and a conventional (collodion bag) cell block only when there was a visible pellet after centrifugation.
Results: In the OSE cohort, 1.4 OSEs were performed per case, and sufficient material remained in 25% for a cell block, though with generally sparse cellularity. 13% of OSE FNAs were Unsatisfactory for diagnosis compared to 11% in the cohort without OSE. The rates of gray-zone diagnoses (atypical plus suspicious) were 19% with OSE and 11% without OSE (p< .1). 6/19 atypical FNAs with OSE had cancer at follow-up compared to only 1/13 atypical FNA without OSE (a case without a rapid cell block). Neither cohort had false positive diagnoses, or cancers if the FNA was negative. Time per OSE was estimated at 25 minutes for pathologists and 15 minutes (extra) for mammographers for a savings of 35 and 21 minutes per case, respectively. At Medicare reimbursement rates for OSE and cell blocks, the cost per patient was reduced by $48.
Conclusions: Our results suggest that replacing OSE with efficient cell blocks can provide more clear-cut results, while saving time for pathologists and clinicians, and saving health care dollars.
Category: Cytopathology

Wednesday, March 28, 2007

Poster # 29, Wednesday Morning