High Diagnostic Accuracy of FNAC Performed in a One Stop Clinic for the Diagnostic for Breast Lesions: A 3-Years Experience with 1822 Specimens
P Vielh, I Borget, C Caramella, C Balleyguier, V Suciu, C Uzan, J Domont, M Mathieu, C Dromain, S Delaloge. Institut de Cancérologie Gustave Roussy, Villejuif, France
Background: Fine-needle aspiration cytology (FNAC) is used extensively in the breast lesions diagnosis, but false-negative rates are a matter of concern. Immediate onsite evaluation of breast lesions, combining FNAC results with clinical and radiological data improves its diagnostic accuracy. The objective of this study was to evaluate the diagnostic accuracy of a large series of FNAC of breast lesions during the first 3-year period of the dedicated one-stop clinic, by comparing the FNAC results with the corresponding definitive histological examination outcome or the results of the radiological follow-up at 18 months.
Design: Data of consecutive patients (pts) whose lesions were prospectively characterized by ultrasonography (US) and diagnosed by FNAC in the one stop clinic of the Institute Gustave Roussy between May 2004 and March 2007. Histological verification by core-needle biopsy or surgery was systematically performed for lesions classified malignant or suspicious by cytopathology, and for benign lesions, when no perfect concordance between clinico-radiologic features and FNAC results (such as benign FNAC but BI-RAD 5) was found. For non-operated patients, follow-up consisted on US and/or mammography. For each cytopathological category, likelihood ratio (LR) was calculated as the ratio of the proportion of breast lesions with cancer and classified in a given cytopathological category to the proportion of breast lesions without cancer and classified in the same cytopathological category. Pts characteristics, radiological findings, cytopathological and histological results were extracted from the hospital computerized prospectively registered medical records.
Results: 1822 breast lesions (mean size 20 mm, BI-RAD ACR 1/2/3/4/5/ unknown: 10/96/471/459/777/9) in 1739 pts (mean age 56 years) were studied. FNAC was US-guided in 1115 lesions. Lesions were classified by FNAC as malignant in 842 (46%), benign in 771 (42%), suspicious in 154 (9%), and unsatisfactory in 55 (3%) cases. LR for malignancy were respectively estimated at 129 and 2,4 for lesions classified as malignant and suspicious in cytopathology, and reached respectively 0.4 and 0.036 in lesions unsatisfactory and benign in cytopathology.
Conclusions: Breast FNAC performed in a dedicated one-stop clinic with immediate on-site diagnosis represented a very efficient tool for triaging patients candidates for histological evaluation or for follow-up by imaging.
Monday, March 22, 2010 1:00 PM
Poster Session II # 30, Monday Afternoon