Skip to main content

Breast Cancer: Pathology, Cytology, and Core Needle Biopsy Methods for Diagnosis

  • Chapter
  • First Online:
Breast and Gynecological Cancers

Abstract

Successful cancer treatment relies on a combination of clinical examinations, imaging studies, and pathologic evaluations. Pathologic diagnosis should not be bypassed even when health care resources are very limited and clinical/radiologic findings are very suggestive of breast cancer. A timely and accurate pathologic diagnosis can be achieved by the use of appropriate tissue sampling techniques, optimal tissue processing, and competent interpretation of pathologic findings. Accurate preoperative pathologic diagnosis confirms the malignant nature of the lesion and documents baseline expression of prognostic and predictive biomarkers, thus enabling clinicians to make optimal therapeutic strategies such as planning the extent of the surgery. Methods of obtaining tissue samples and the cytohistological techniques and histopathological features of the spectrum of breast cancer pathology are discussed in detail.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55(2):74–108.

    Article  PubMed  Google Scholar 

  2. Anderson BO, Jakesz R. Breast cancer issues in developing countries: an overview of the Breast Health Global Initiative. World J Surg. 2008;32(12):2578–85.

    Article  PubMed  Google Scholar 

  3. Shyyan R, Masood S, Badwe RA, et al. Breast cancer in limited-resource countries: diagnosis and pathology. Breast J. 2006;12 Suppl 1:S27–37.

    Article  PubMed  Google Scholar 

  4. Vargas HI, Masood S. Implementation of a minimally invasive breast biopsy program in countries with limited resources. Breast J. 2003;9 Suppl 2:S81–5.

    Article  PubMed  Google Scholar 

  5. Lannin DR, Silverman JF, Walker C, Pories WJ. Cost-effectiveness of fine needle biopsy of the breast. Ann Surg. 1986;203(5):474–80.

    Article  CAS  PubMed  Google Scholar 

  6. Logan-Young W, Dawson AE, Wilbur DC, et al. The cost-effectiveness of fine-needle aspiration cytology and 14-gauge core needle biopsy compared with open surgical biopsy in the diagnosis of breast carcinoma. Cancer. 1998;82(10):1867–73.

    Article  CAS  PubMed  Google Scholar 

  7. Rimm DL, Stastny JF, Rimm EB, Ayer S, Frable WJ. Comparison of the costs of fine-needle aspiration and open surgical biopsy as methods for obtaining a pathologic diagnosis. Cancer. 1997;81(1):51–6.

    Article  CAS  PubMed  Google Scholar 

  8. Cobb CJ, Raza AS. Obituary: “alas poor FNA of breast—we knew thee well!”. Diagn Cytopathol. 2005;32(1):1–4.

    Article  PubMed  Google Scholar 

  9. Feoli F, Paesmans M, Van Eeckhout P. Fine needle aspiration cytology of the breast: impact of experience on accuracy, using standardized cytologic criteria. Acta Cytol. 2008;52(2):145–51.

    Article  PubMed  Google Scholar 

  10. Howell LP. Equivocal diagnoses in breast aspiration biopsy cytology: sources of uncertainty and the role of “atypical/indeterminate” terminology. Diagn Cytopathol. 1999;21(3):217–22.

    Article  CAS  PubMed  Google Scholar 

  11. Chaiwun B, Settakorn J, Ya-In C, Wisedmongkol W, Rangdaeng S, Thorner P. Effectiveness of fine-needle aspiration cytology of breast: analysis of 2,375 cases from northern Thailand. Diagn Cytopathol. 2002;26(3):201–5.

    Article  PubMed  Google Scholar 

  12. Hussain MT. Comparison of fine needle aspiration cytology with excision biopsy of breast lump. J Coll Physicians Surg Pak. 2005;15(4):211–4.

    PubMed  Google Scholar 

  13. Medina-Franco H, Abarca-Perez L, Cortes-Gonzalez R, Soto-Germes S, Ulloa JA, Uribe N. [Fine needle aspiration biopsy of breast lesions: institutional experience]. Rev Invest Clin. 2005;57(3):394–8.

    PubMed  Google Scholar 

  14. Bulgaresi P, Cariaggi P, Ciatto S, Houssami N. Positive predictive value of breast fine needle aspiration cytology (FNAC) in combination with clinical and imaging findings: a series of 2334 subjects with abnormal cytology. Breast Cancer Res Treat. 2006;97(3):319–21.

    Article  CAS  PubMed  Google Scholar 

  15. Orell SR, Miliauskas J. Fine needle biopsy cytology of breast lesions: a review of interpretative difficulties. Adv Anat Pathol. 2005;12(5):233–45.

    Article  PubMed  Google Scholar 

  16. Zagorianakou P, Fiaccavento S, Zagorianakou N, Makrydimas G, Stefanou D, Agnantis NJ. FNAC: its role, limitations and perspective in the preoperative diagnosis of breast cancer. Eur J Gynaecol Oncol. 2005;26(2):143–9.

    CAS  PubMed  Google Scholar 

  17. Lau SK, McKee GT, Weir MM, Tambouret RH, Eichhorn JH, Pitman MB. The negative predicative value of breast fine-needle aspiration biopsy: the Massachusetts General Hospital experience. Breast J. 2004;10(6):487–91.

    Article  PubMed  Google Scholar 

  18. Mizuno S, Isaji S, Ogawa T, et al. Approach to fine-needle aspiration cytology-negative cases of breast cancer. Asian J Surg. 2005;28(1):13–7.

    Article  PubMed  Google Scholar 

  19. Tariq GR, Haleem A, Zaidi AH, Afzal M, Abbasi S. Role of FNA cytology in the management of carcinoma breast. J Coll Physicians Surg Pak. 2005;15(4):207–10.

    PubMed  Google Scholar 

  20. Das DK. Fine-needle aspiration cytology: its origin, development, and present status with special reference to a developing country, India. Diagn Cytopathol. 2003;28(6):345–51.

    Article  PubMed  Google Scholar 

  21. Britton PD, Flower CD, Freeman AH, et al. Changing to core biopsy in an NHS breast screening unit. Clin Radiol. 1997;52(10):764–7.

    Article  CAS  PubMed  Google Scholar 

  22. Gordon PB. Image-directed fine needle aspiration biopsy in nonpalpable breast lesions. Clin Lab Med. 2005;25(4):655–78, v.

    Google Scholar 

  23. Clarke D, Sudhakaran N, Gateley CA. Replace fine needle aspiration cytology with automated core biopsy in the triple assessment of breast cancer. Ann R Coll Surg Engl. 2001;83(2):110–2.

    CAS  PubMed  Google Scholar 

  24. Meunier M, Clough K. Fine needle aspiration cytology versus percutaneous biopsy of nonpalpable breast lesions. Eur J Radiol. 2002;42(1):10–6.

    Article  CAS  PubMed  Google Scholar 

  25. Oyama T, Koibuchi Y, McKee G. Core needle biopsy (CNB) as a diagnostic method for breast lesions: comparison with fine needle aspiration cytology (FNA). Breast Cancer. 2004;11(4):339–42.

    Article  PubMed  Google Scholar 

  26. Shukla R, Pooja B, Radhika S, Nijhawan R, Rajwanshi A. Fine-needle aspiration cytology of extramammary neoplasms metastatic to the breast. Diagn Cytopathol. 2005;32(4):193–7.

    Article  CAS  PubMed  Google Scholar 

  27. Smymiotis V, Theodosopoulos T, Marinis A, Goula K, Psychogios J, Kondi-Pafiti A. Metastatic disease in the breast from nonmammary neoplasms. Eur J Gynaecol Oncol. 2005;26(5):547–50.

    CAS  PubMed  Google Scholar 

  28. Berna-Serna JD, Madrigal M. Percutaneous management of breast abscesses. An experience of 39 cases. Ultrasound Med Biol. 2004;30(1):1–6.

    Article  PubMed  Google Scholar 

  29. Mehrotra R. Fine needle aspiration diagnosis of tuberculous mastitis. Indian J Pathol Microbiol. 2004;47(3):377–80.

    PubMed  Google Scholar 

  30. Levine PH, Zamuco R, Yee HT. Role of fine-needle aspiration cytology in breast lymphoma. Diagn Cytopathol. 2004;30(5):332–40.

    Article  PubMed  Google Scholar 

  31. Geramizadeh B, Kaboli R, Vasei M. Fine needle aspiration cytology of Burkitt’s lymphoma presenting as a breast mass. Acta Cytol. 2004;48(2):285–6.

    Article  PubMed  Google Scholar 

  32. Rao R, Lilley L, Andrews V, Radford L, Ulissey M. Axillary staging by percutaneous biopsy: sensitivity of fine-needle aspiration versus core needle biopsy. Ann Surg Oncol. 2009;16(5):1170–5.

    Article  PubMed  Google Scholar 

  33. Wallis M, Tardivon A, Helbich T, Schreer I. Guidelines from the European Society of Breast Imaging for diagnostic interventional breast procedures. Eur Radiol. 2007;17(2):581–8.

    Article  PubMed  Google Scholar 

  34. Costantini R, Sardellone A, Marino C, Giamberardino MA, Innocenti P, Napolitano AM. Vacuum-assisted core biopsy (Mammotome) for the diagnosis of non-palpable breast lesions: four-year experience in an Italian center. Tumori. 2005;91(4):351–4.

    PubMed  Google Scholar 

  35. Dhillon MS, Bradley SA, England DW. Mammotome biopsy: impact on preoperative diagnosis rate. Clin Radiol. 2006;61(3):276–81.

    Article  CAS  PubMed  Google Scholar 

  36. Killebrew LK, Oneson RH. Comparison of the diagnostic accuracy of a vacuum-assisted percutaneous intact specimen sampling device to a vacuum-assisted core needle sampling device for breast biopsy: initial experience. Breast J. 2006;12(4):302–8.

    Article  PubMed  Google Scholar 

  37. Symmans WF, Weg N, Gross J, et al. A prospective comparison of stereotaxic fine-needle aspiration versus stereotaxic core needle biopsy for the diagnosis of mammographic abnormalities. Cancer. 1999;85(5):1119–32.

    Article  CAS  PubMed  Google Scholar 

  38. Jayaram G, Sthaneshwar P. Fine-needle aspiration cytology of phyllodes tumors. Diagn Cytopathol. 2002;26(4):222–7.

    Article  PubMed  Google Scholar 

  39. Scolyer RA, McKenzie PR, Achmed D, Lee CS. Can phyllodes tumours of the breast be distinguished from fibroadenomas using fine needle aspiration cytology? Pathology. 2001;33(4):437–43.

    Article  CAS  PubMed  Google Scholar 

  40. Tse GM, Ma TK, Pang LM, Cheung H. Fine needle aspiration cytologic features of mammary phyllodes tumors. Acta Cytol. 2002;46(5):855–63.

    Article  PubMed  Google Scholar 

  41. Veneti S, Manek S. Benign phyllodes tumour vs fibroadenoma: FNA cytological differentiation. Cytopathology. 2001;12(5):321–8.

    Article  CAS  PubMed  Google Scholar 

  42. Simsir A, Waisman J, Thorner K, Cangiarella J. Mammary lesions diagnosed as “papillary” by aspiration biopsy: 70 cases with follow-up. Cancer. 2003;99(3):156–65.

    Article  PubMed  Google Scholar 

  43. Lopez-Ferrer P, Jimenez-Heffernan JA, Vicandi B, Ortega L, Viguer JM. Fine needle aspiration cytology of breast fibroadenoma. A cytohistologic correlation study of 405 cases. Acta Cytol. 1999;43(4):579–86.

    Article  CAS  PubMed  Google Scholar 

  44. Simsir A, Tsang P, Greenebaum E. Additional mimics of mucinous mammary carcinoma: fibroepithelial lesions. Am J Clin Pathol. 1998;109(2):169–72.

    CAS  PubMed  Google Scholar 

  45. Yeoh GP, Cheung PS, Chan KW. Fine-needle aspiration cytology of mucocelelike tumors of the breast. Am J Surg Pathol. 1999;23(5):552–9.

    Article  CAS  PubMed  Google Scholar 

  46. Kundu UR, Guo M, Landon G, Wu Y, Sneige N, Gong Y. Fine-needle aspiration cytology of sclerosing adenosis of the breast: a retrospective review of cytologic features in conjunction with corresponding histologic features and radiologic findings. Am J Clin Pathol. 2012;138(1):96–102.

    Article  PubMed  Google Scholar 

  47. Cho EY, Oh YL. Fine needle aspiration cytology of sclerosing adenosis of the breast. Acta Cytol. 2001;45(3):353–9.

    Article  CAS  PubMed  Google Scholar 

  48. Abendroth CS, Wang HH, Ducatman BS. Comparative features of carcinoma in situ and atypical ductal hyperplasia of the breast on fine-needle aspiration biopsy specimens. Am J Clin Pathol. 1991;96(5):654–9.

    CAS  PubMed  Google Scholar 

  49. Lilleng R, Hagmar BM, Farrants G. Low-grade cribriform ductal carcinoma in situ of the breast. Fine needle aspiration cytology in three cases. Acta Cytol. 1992;36(1):48–54.

    CAS  PubMed  Google Scholar 

  50. Venegas R, Rutgers JL, Cameron BL, Vargas H, Butler JA. Fine needle aspiration cytology of breast ductal carcinoma in situ. Acta Cytol. 1994;38(2):136–43.

    CAS  PubMed  Google Scholar 

  51. Leifland K, Lundquist H, Mare K, Erhardt K, Fernstad R. Pre-operative simultaneous stereotactic core biopsy and fine-needle aspiration biopsy in the diagnosis of invasive lobular breast carcinoma. Acta Radiol. 2000;41(1):57–60.

    Article  CAS  PubMed  Google Scholar 

  52. Bondeson L, Lindholm K. Aspiration cytology of tubular breast carcinoma. Acta Cytol. 1990;34(1):15–20.

    CAS  PubMed  Google Scholar 

  53. Cangiarella J, Waisman J, Shapiro RL, Simsir A. Cytologic features of tubular adenocarcinoma of the breast by aspiration biopsy. Diagn Cytopathol. 2001;25(5):311–5.

    Article  CAS  PubMed  Google Scholar 

  54. Dawson AE, Logan-Young W, Mulford DK. Aspiration cytology of tubular carcinoma. Diagnostic features with mammographic correlation. Am J Clin Pathol. 1994;101(4):488–92.

    CAS  PubMed  Google Scholar 

  55. Dei Tos AP, Della Giustina D, De Martin V, Della Libera D, Bittesini L. Aspiration biopsy cytology of tubular carcinoma of the breast. Diagn Cytopathol. 1994;11(2):146–50.

    Article  CAS  PubMed  Google Scholar 

  56. Fischler DF, Sneige N, Ordonez NG, Fornage BD. Tubular carcinoma of the breast: cytologic features in fine-needle aspirations and application of monoclonal anti-alpha-smooth muscle actin in diagnosis. Diagn Cytopathol. 1994;10(2):120–5.

    Article  CAS  PubMed  Google Scholar 

  57. Gupta RK, Dowle CS. Fine needle aspiration cytology of tubular carcinoma of the breast. Acta Cytol. 1997;41(4):1139–43.

    Article  CAS  PubMed  Google Scholar 

  58. de la Torre M, Lindholm K, Lindgren A. Fine needle aspiration cytology of tubular breast carcinoma and radial scar. Acta Cytol. 1994;38(6):884–90.

    PubMed  Google Scholar 

  59. Arisio R, Cuccorese C, Accinelli G, Mano MP, Bordon R, Fessia L. Role of fine-needle aspiration biopsy in breast lesions: analysis of a series of 4,110 cases. Diagn Cytopathol. 1998;18(6):462–7.

    Article  CAS  PubMed  Google Scholar 

  60. Greeley CF, Frost AR. Cytologic features of ductal and lobular carcinoma in fine needle aspirates of the breast. Acta Cytol. 1997;41(2):333–40.

    Article  CAS  PubMed  Google Scholar 

  61. Joshi A, Kumar N, Verma K. Diagnostic challenge of lobular carcinoma on aspiration cytology. Diagn Cytopathol. 1998;18(3):179–83.

    Article  CAS  PubMed  Google Scholar 

  62. Leach C, Howell LP. Cytodiagnosis of classic lobular carcinoma and its variants. Acta Cytol. 1992;36(2):199–202.

    CAS  PubMed  Google Scholar 

  63. Lerma E, Fumanal V, Carreras A, Esteva E, Prat J. Undetected invasive lobular carcinoma of the breast: review of false-negative smears. Diagn Cytopathol. 2000;23(5):303–7.

    Article  CAS  PubMed  Google Scholar 

  64. Rajesh L, Dey P, Joshi K. Fine needle aspiration cytology of lobular breast carcinoma. Comparison with other breast lesions. Acta Cytol. 2003;47(2):177–82.

    Article  PubMed  Google Scholar 

  65. Sadler GP, McGee S, Dallimore NS, et al. Role of fine-needle aspiration cytology and needle-core biopsy in the diagnosis of lobular carcinoma of the breast. Br J Surg. 1994;81(9):1315–7.

    Article  CAS  PubMed  Google Scholar 

  66. Bondeson L, Lindholm K. Prediction of invasiveness by aspiration cytology applied to nonpalpable breast carcinoma and tested in 300 cases. Diagn Cytopathol. 1997;17(5):315–20.

    Article  CAS  PubMed  Google Scholar 

  67. Maygarden SJ, Brock MS, Novotny DB. Are epithelial cells in fat or connective tissue a reliable indicator of tumor invasion in fine-needle aspiration of the breast? Diagn Cytopathol. 1997;16(2):137–42.

    Article  CAS  PubMed  Google Scholar 

  68. McKee GT, Tambouret RH, Finkelstein D. Fine-needle aspiration cytology of the breast: invasive vs. in situ carcinoma. Diagn Cytopathol. 2001;25(1):73–7.

    Article  CAS  PubMed  Google Scholar 

  69. Shin HJ, Sneige N. Is a diagnosis of infiltrating versus in situ ductal carcinoma of the breast possible in fine-needle aspiration specimens? Cancer. 1998;84(3):186–91.

    Article  CAS  PubMed  Google Scholar 

  70. Sauer T, Garred O, Lomo J, Naess O. Assessing invasion criteria in fine needle aspirates from breast carcinoma diagnosed as DICS or invasive carcinoma: can we identify an invasive component in addition to DCIS? Acta Cytol. 2006;50(3):263–70.

    Article  PubMed  Google Scholar 

  71. Bofin AM, Lydersen S, Hagmar BM. Cytological criteria for the diagnosis of intraductal hyperplasia, ductal carcinoma in situ, and invasive carcinoma of the breast. Diagn Cytopathol. 2004;31(4):207–15.

    Article  PubMed  Google Scholar 

  72. Masood S, Loya A, Khalbuss W. Is core needle biopsy superior to fine-needle aspiration biopsy in the diagnosis of papillary breast lesions? Diagn Cytopathol. 2003;28(6):329–34.

    Article  PubMed  Google Scholar 

  73. Hoda SA, Rosen PP. Practical considerations in the pathologic diagnosis of needle core biopsies of breast. Am J Clin Pathol. 2002;118(1):101–8.

    Article  PubMed  Google Scholar 

  74. Masood S. Core needle biopsy versus fine needle aspiration biopsy: are there similar sampling and diagnostic issues? Clin Lab Med. 2005;25(4):679–88, vi.

    Google Scholar 

  75. Dillon MF, McDermott EW, Quinn CM, O’Doherty A, O’Higgins N, Hill AD. Predictors of invasive disease in breast cancer when core biopsy demonstrates DCIS only. J Surg Oncol. 2006;93(7):559–63.

    Article  PubMed  Google Scholar 

  76. Meijnen P, Oldenburg HS, Loo CE, Nieweg OE, Peterse JL, Rutgers EJ. Risk of invasion and axillary lymph node metastasis in ductal carcinoma in situ diagnosed by core-needle biopsy. Br J Surg. 2007;94(8):952–6.

    Article  CAS  PubMed  Google Scholar 

  77. Farshid G, Pieterse S. Core imprint cytology of screen-detected breast lesions is predictive of the histologic results. Cancer. 2006;108(3):150–6.

    Article  PubMed  Google Scholar 

  78. Ballo MS, Sneige N. Can core needle biopsy replace fine-needle aspiration cytology in the diagnosis of palpable breast carcinoma. A comparative study of 124 women. Cancer. 1996;78(4):773–7.

    Article  CAS  PubMed  Google Scholar 

  79. Fornage BD. Sonographically guided needle biopsy of nonpalpable breast lesions. J Clin Ultrasound. 1999;27(7):385–98.

    Article  CAS  PubMed  Google Scholar 

  80. He Q, Fan X, Yuan T, et al. Eleven years of experience reveals that fine-needle aspiration cytology is still a useful method for preoperative diagnosis of breast carcinoma. Breast. 2007;16(3):303–6.

    Article  PubMed  Google Scholar 

  81. Bonneau C, Lebas P, Michenet P. [Histologic changes after stereotactic 11-gauge directional vacuum assisted breast biopsy for mammary calcification: experience in 31 surgical specimens]. Ann Pathol. 2002;22(6):441–7.

    PubMed  Google Scholar 

  82. Yang JH, Lee WS, Kim SW, Woo SU, Kim JH, Nam SJ. Effect of core-needle biopsy vs fine-needle aspiration on pathologic measurement of tumor size in breast cancer. Arch Surg. 2005;140(2):125–8.

    Article  PubMed  Google Scholar 

  83. Docktor BJ, MacGregor JH, Burrowes PW. Ultrasonographic findings 6 months after 11-gauge vacuum-assisted large-core breast biopsy. Can Assoc Radiol J. 2004;55(3):151–6.

    PubMed  Google Scholar 

  84. Ariga R, Bloom K, Reddy VB, et al. Fine-needle aspiration of clinically suspicious palpable breast masses with histopathologic correlation. Am J Surg. 2002;184(5):410–3.

    Article  PubMed  Google Scholar 

  85. Liao J, Davey DD, Warren G, Davis J, Moore AR, Samayoa LM. Ultrasound-guided fine-needle aspiration biopsy remains a valid approach in the evaluation of nonpalpable breast lesions. Diagn Cytopathol. 2004;30(5):325–31.

    Article  PubMed  Google Scholar 

  86. Zardawi IM, Hearnden F, Meyer P, Trevan B. Ultrasound-guided fine needle aspiration cytology of impalpable breast lesions in a rural setting. Comparison of cytology with imaging and final outcome. Acta Cytol. 1999;43(2):163–8.

    Article  CAS  PubMed  Google Scholar 

  87. Mansoor I, Jamal AA. Role of fine needle aspiration in diagnosing breast lesions. Saudi Med J. 2002;23(8):915–20.

    PubMed  Google Scholar 

  88. Homesh NA, Issa MA, El-Sofiani HA. The diagnostic accuracy of fine needle aspiration cytology versus core needle biopsy for palpable breast lump(s). Saudi Med J. 2005;26(1):42–6.

    PubMed  Google Scholar 

  89. Usami S, Moriya T, Kasajima A, et al. Pathological aspects of core needle biopsy for non-palpable breast lesions. Breast Cancer. 2005;12(4):272–8.

    Article  PubMed  Google Scholar 

  90. Verkooijen HM. Diagnostic accuracy of stereotactic large-core needle biopsy for nonpalpable breast disease: results of a multicenter prospective study with 95% surgical confirmation. Int J Cancer. 2002;99(6):853–9.

    Article  CAS  PubMed  Google Scholar 

  91. Westenend PJ, Sever AR, Beekman-De Volder HJ, Liem SJ. A comparison of aspiration cytology and core needle biopsy in the evaluation of breast lesions. Cancer. 2001;93(2):146–50.

    Article  CAS  PubMed  Google Scholar 

  92. Dennison G, Anand R, Makar SH, Pain JA. A prospective study of the use of fine-needle aspiration cytology and core biopsy in the diagnosis of breast cancer. Breast J. 2003;9(6):491–3.

    Article  CAS  PubMed  Google Scholar 

  93. Veneti S, Daskalopoulou D, Zervoudis S, Papasotiriou E, Ioannidou-Mouzaka L. Liquid-based cytology in breast fine needle aspiration. Comparison with the conventional smear. Acta Cytol. 2003;47(2):188–92.

    Article  PubMed  Google Scholar 

  94. Kontzoglou K, Moulakakis KG, Konofaos P, Kyriazi M, Kyroudes A, Karakitsos P. The role of liquid-based cytology in the investigation of breast lesions using fine-needle aspiration: a cytohistopathological evaluation. J Surg Oncol. 2005;89(2):75–8.

    Article  PubMed  Google Scholar 

  95. Biscotti CV, Shorie JH, Gramlich TL, Easley KA. ThinPrep vs. conventional smear cytologic preparations in analyzing fine-needle aspiration specimens from palpable breast masses. Diagn Cytopathol. 1999;21(2):137–41.

    Article  CAS  PubMed  Google Scholar 

  96. Joseph L, Edwards JM, Nicholson CM, Pitt MA, Howat AJ. An audit of the accuracy of fine needle aspiration using a liquid-based cytology system in the setting of a rapid access breast clinic. Cytopathology. 2002;13(6):343–9.

    Article  CAS  PubMed  Google Scholar 

  97. Howell LP, Gandour-Edwards R, Folkins K, Davis R, Yasmeen S, Afify A. Adequacy evaluation of fine-needle aspiration biopsy in the breast health clinic setting. Cancer. 2004;102(5):295–301.

    Article  PubMed  Google Scholar 

  98. Daltrey IR, Kissin MW. Randomized clinical trial of the effect of needle gauge and local anaesthetic on the pain of breast fine-needle aspiration cytology. Br J Surg. 2000;87(6):777–9.

    Article  CAS  PubMed  Google Scholar 

  99. Satchithananda K, Fernando RA, Ralleigh G, et al. An audit of pain/discomfort experienced during image-guided breast biopsy procedures. Breast J. 2005;11(6):398–402.

    Article  PubMed  Google Scholar 

  100. Zagouri F, Sergentanis TN, Gounaris A, et al. Pain in different methods of breast biopsy: emphasis on vacuum-assisted breast biopsy. Breast. 2008;17(1):71–5.

    Article  PubMed  Google Scholar 

  101. Bates T, Davidson T, Mansel RE. Litigation for pneumothorax as a complication of fine-needle aspiration of the breast. Br J Surg. 2002;89(2):134–7.

    CAS  PubMed  Google Scholar 

  102. Kaufman Z, Shpitz B, Shapiro M, Dinbar A. Pneumothorax. A complication of fine needle aspiration of breast tumors. Acta Cytol. 1994;38(5):737–8.

    CAS  PubMed  Google Scholar 

  103. Lee KC, Chan JK, Ho LC. Histologic changes in the breast after fine-needle aspiration. Am J Surg Pathol. 1994;18(10):1039–47.

    Article  CAS  PubMed  Google Scholar 

  104. Pinto RG, Couto F, Mandreker S. Infarction after fine needle aspiration. A report of four cases. Acta Cytol. 1996;40(4):739–41.

    Article  CAS  PubMed  Google Scholar 

  105. Florentine BD, Cobb CJ, Frankel K, Greaves T, Martin SE. Core needle biopsy. A useful adjunct to fine-needle aspiration in select patients with palpable breast lesions. Cancer. 1997;81(1):33–9.

    Article  CAS  PubMed  Google Scholar 

  106. Abati A. Uniform approach to breast aspirates: the quest becomes reality. Diagn Cytopathol. 1996;15(1):vii–viii.

    Article  CAS  PubMed  Google Scholar 

  107. National Cancer Institute Fine-Needle Aspiration of Breast Workshop Subcommittees. The uniform approach to breast fine-needle aspiration biopsy. Diagn Cytopathol. 1997;16(4):295–311.

    Google Scholar 

  108. Ozkara SK, Ustun MO, Paksoy N. The gray zone in breast fine needle aspiration cytology. How to report on it? Acta Cytol. 2002;46(3):513–8.

    Article  PubMed  Google Scholar 

  109. Pisano ED, Fajardo LL, Tsimikas J, et al. Rate of insufficient samples for fine-needle aspiration for nonpalpable breast lesions in a multicenter clinical trial: The Radiologic Diagnostic Oncology Group 5 Study. The RDOG5 investigators. Cancer. 1998;82(4):679–88.

    Article  CAS  PubMed  Google Scholar 

  110. Nasuti JF, Gupta PK, Baloch ZW. Diagnostic value and cost-effectiveness of on-site evaluation of fine-needle aspiration specimens: review of 5,688 cases. Diagn Cytopathol. 2002;27(1):1–4.

    Article  PubMed  Google Scholar 

  111. Houssami N, Ciatto S, Ambrogetti D, et al. Florence-Sydney Breast Biopsy Study: sensitivity of ultrasound-guided versus freehand fine needle biopsy of palpable breast cancer. Breast Cancer Res Treat. 2005;89(1):55–9.

    Article  CAS  PubMed  Google Scholar 

  112. Robinson IA, McKee G, Kissin MW. Typing and grading breast carcinoma on fine-needle aspiration: is this clinically useful information? Diagn Cytopathol. 1995;13(3):260–5.

    Article  CAS  PubMed  Google Scholar 

  113. Mouriquand J, Pasquier D. Fine needle aspiration of breast carcinoma: a preliminary cytoprognostic study. Acta Cytol. 1980;24(2):153–9.

    CAS  PubMed  Google Scholar 

  114. Robinson IA, McKee G, Nicholson A, et al. Prognostic value of cytological grading of fine-needle aspirates from breast carcinomas. Lancet. 1994;343(8903):947–9.

    Article  CAS  PubMed  Google Scholar 

  115. Fisher ER, Redmond C, Fisher B. Histologic grading of breast cancer. Pathol Annu. 1980;15(Pt 1):239–51.

    CAS  PubMed  Google Scholar 

  116. Zoppi JA, Pellicer EM, Sundblad AS. Cytohistologic correlation of nuclear grade in breast carcinoma. Acta Cytol. 1997;41(3):701–4.

    Article  CAS  PubMed  Google Scholar 

  117. Wani FA, Bhardwaj S, Kumar D, Katoch P. Cytological grading of breast cancers and comparative evaluation of two grading systems. J Cytol. 2010;27(2):55–8.

    Article  PubMed  Google Scholar 

  118. Robles-Frias A, Gonzalez-Campora R, Martinez-Parra D, et al. Robinson cytologic grading of invasive ductal breast carcinoma: correlation with histologic grading and regional lymph node metastasis. Acta Cytol. 2005;49(2):149–53.

    Article  PubMed  Google Scholar 

  119. Zafar N, Jamal S, Mamoon N, Luqman M, Anwar M. Typing and grading of cytological category C5 breast lesions. J Coll Physicians Surg Pak. 2005;15(4):221–4.

    PubMed  Google Scholar 

  120. Chaiwun B, Sukhamwang N, Lekawanvijit S, et al. Atypical and suspicious categories in fine needle aspiration cytology of the breast: histological and mammographical correlation and clinical significance. Singapore Med J. 2005;46(12):706–9.

    CAS  PubMed  Google Scholar 

  121. Bak M, Szabo E, Mandoky L. [The “gray zone” in fine needle aspiration cytology of the breast]. Magy Seb. 2005;58(1):3–7.

    PubMed  Google Scholar 

  122. Mander BJ, Beresford PA, Tildsley G, Qureshi T, Wishart GC. Management of patients with intermediate (C3) cytology and a solitary breast lump. Breast. 2001;10(2):163–5.

    Article  CAS  PubMed  Google Scholar 

  123. Boerner S, Fornage BD, Singletary E, Sneige N. Ultrasound-guided fine-needle aspiration (FNA) of nonpalpable breast lesions: a review of 1885 FNA cases using the National Cancer Institute-supported recommendations on the uniform approach to breast FNA. Cancer. 1999;87(1):19–24.

    Article  CAS  PubMed  Google Scholar 

  124. Deb RA, Matthews P, Elston CW, Ellis IO, Pinder SE. An audit of “equivocal” (C3) and “suspicious” (C4) categories in fine needle aspiration cytology of the breast. Cytopathology. 2001;12(4):219–26.

    Article  CAS  PubMed  Google Scholar 

  125. Kanhoush R, Jorda M, Gomez-Fernandez C, et al. ‘Atypical’ and ‘suspicious’ diagnoses in breast aspiration cytology. Cancer. 2004;102(3):164–7.

    Article  PubMed  Google Scholar 

  126. Hukkinen K, Kivisaari L, Heikkila PS, Von Smitten K, Leidenius M. Unsuccessful preoperative biopsies, fine needle aspiration cytology or core needle biopsy, lead to increased costs in the diagnostic workup in breast cancer. Acta Oncol. 2008;47(6):1037–45.

    Article  PubMed  Google Scholar 

  127. Dabbs DJ, Abendroth CS, Grenko RT, Wang X, Radcliffe GE. Immunocytochemistry on the Thinprep processor. Diagn Cytopathol. 1997;17(5):388–92.

    Article  CAS  PubMed  Google Scholar 

  128. Guiter GE, Gatscha RM, Zakowski MF. ThinPrep vs. conventional smears in fine-needle aspirations of sarcomas: a morphological and immunocytochemical study. Diagn Cytopathol. 1999;21(5):351–4.

    Article  CAS  PubMed  Google Scholar 

  129. Leung SW, Bedard YC. Immunocytochemical staining on ThinPrep processed smears. Mod Pathol. 1996;9(3):304–6.

    CAS  PubMed  Google Scholar 

  130. Gong Y, Joseph T, Sneige N. Validation of commonly used immunostains on cell-transferred cytologic specimens. Cancer. 2005;105(3):158–64.

    Article  PubMed  Google Scholar 

  131. Mehta P, Battifora H. How to do multiple immunostains when only one tissue slide is available. The “peel and stick” method. Appl Immunohistochem. 1993;1:297–8.

    Google Scholar 

  132. Miller RT, Kubier P. Immunohistochemistry on cytologic specimens and previously stained slides (when no paraffin block is available). J Histotechnol. 2002;25(4):251–7.

    Article  Google Scholar 

  133. Sherman ME, Jimenez-Joseph D, Gangi MD, Rojas-Corona RR. Immunostaining of small cytologic specimens. Facilitation with cell transfer. Acta Cytol. 1994;38(1):18–22.

    CAS  PubMed  Google Scholar 

  134. Goldstein NS, Ferkowicz M, Odish E, Mani A, Hastah F. Minimum formalin fixation time for consistent estrogen receptor immunohistochemical staining of invasive breast carcinoma. Am J Clin Pathol. 2003;120(1):86–92.

    Article  PubMed  Google Scholar 

  135. Hammond ME, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. Arch Pathol Lab Med. 2010;134(6):907–22.

    PubMed  Google Scholar 

  136. Wolff AC, Hammond ME, Schwartz JN, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. J Clin Oncol. 2007;25(1):118–45.

    Article  CAS  PubMed  Google Scholar 

  137. Confortini M, Carozzi F, Bozzola L, et al. Interlaboratory reproducibility of the immunocytochemical assessment of oestrogen and progesterone receptors and proliferative activity in fine needle aspiration of breast cancer. Cytopathology. 2002;13(2):92–100.

    Article  CAS  PubMed  Google Scholar 

  138. Masood S. Estrogen and progesterone receptors in cytology: a comprehensive review. Diagn Cytopathol. 1992;8(5):475–91.

    Article  CAS  PubMed  Google Scholar 

  139. Jayaram G, Elsayed EM. Cytologic evaluation of prognostic markers in breast carcinoma. Acta Cytol. 2005;49(6):605–10.

    Article  PubMed  Google Scholar 

  140. Gong Y, Symmans WF, Krishnamurthy S, Patel S, Sneige N. Optimal fixation conditions for immunocytochemical analysis of estrogen receptor in cytologic specimens of breast carcinoma. Cancer. 2004;102(1):34–40.

    Article  CAS  PubMed  Google Scholar 

  141. Petroff BK, Clark JL, Metheny T, Xue Q, Kimler BF, Fabian CJ. Optimization of estrogen receptor ­analysis by immunocytochemistry in random periareolar fine-needle aspiration samples of breast ­tissue ­processed as thin-layer preparations. Appl Immunohistochem Mol Morphol. 2006;14(3):360–4.

    Article  CAS  PubMed  Google Scholar 

  142. Beatty BG, Bryant R, Wang W, et al. HER-2/neu detection in fine-needle aspirates of breast cancer: fluorescence in situ hybridization and immunocytochemical analysis. Am J Clin Pathol. 2004;122(2):246–55.

    Article  CAS  PubMed  Google Scholar 

  143. Nizzoli R, Bozzetti C, Crafa P, et al. Immunocytochemical evaluation of HER-2/neu on fine-needle aspirates from primary breast carcinomas. Diagn Cytopathol. 2003;28(3):142–6.

    Article  PubMed  Google Scholar 

  144. Kocjan G, Bourgain C, Fassina A, et al. The role of breast FNAC in diagnosis and clinical management: a survey of current practice. Cytopathology. 2008;19(5):271–8.

    Article  CAS  PubMed  Google Scholar 

  145. Gu M, Ghafari S, Zhao M. Fluorescence in situ hybridization for HER-2/neu amplification of breast carcinoma in archival fine needle aspiration biopsy specimens. Acta Cytol. 2005;49(5):471–6.

    Article  PubMed  Google Scholar 

  146. Moore JG, To V, Patel SJ, Sneige N. HER-2/neu gene amplification in breast imprint cytology analyzed by fluorescence in situ hybridization: direct comparison with companion tissue sections. Diagn Cytopathol. 2000;23(5):299–302.

    Article  CAS  PubMed  Google Scholar 

  147. Nizzoli R, Guazzi A, Naldi N, Fraciosi V, Bozzetti C. HER-2/neu evaluation by fluorescence in situ hybridization on destained cytologic smears from primary and metastatic breast cancer. Acta Cytol. 2005;49(1):27–30.

    Article  PubMed  Google Scholar 

  148. Tomas AR, Praca MJ, Fonseca R, Andre S, Mendonca E. Assessing HER-2 status in fresh frozen and archival cytological samples obtained by fine needle aspiration cytology. Cytopathology. 2004;15(6):311–4.

    Article  CAS  PubMed  Google Scholar 

  149. Gong Y, Gilcrease M, Sneige N. Reliability of chromogenic in situ hybridization for detecting HER-2 gene status in breast cancer: comparison with fluorescence in situ hybridization and assessment of interobserver reproducibility. Mod Pathol. 2005;18(8):1015–21.

    Article  CAS  PubMed  Google Scholar 

  150. Gong Y, Sweet W, Duh YJ, et al. Chromogenic in situ hybridization is a reliable method for detecting HER2 gene status in breast cancer: a multicenter study using conventional scoring criteria and the new ASCO/CAP recommendations. Am J Clin Pathol. 2009;131(4):490–7.

    Article  CAS  PubMed  Google Scholar 

  151. Gong Y, Sweet W, Duh YJ, et al. Performance of chromogenic in situ hybridization on testing HER2 status in breast carcinomas with chromosome 17 polysomy and equivocal (2+) herceptest results: a study of two institutions using the conventional and new ASCO/CAP scoring criteria. Am J Clin Pathol. 2009;132(2):228–36.

    Article  CAS  PubMed  Google Scholar 

  152. Lin F, Shen T, Prichard JW. Detection of Her-2/neu oncogene in breast carcinoma by chromogenic in situ hybridization in cytologic specimens. Diagn Cytopathol. 2005;33(6):376–80.

    Article  PubMed  Google Scholar 

  153. Sumiyoshi K, Shibayama Y, Akashi S, et al. Detection of human epidermal growth factor receptor 2 protein and gene in fine needle aspiration cytology specimens and tissue sections from invasive breast cancer: can cytology specimens take the place of tissue sections? Oncol Rep. 2006;15(4):803–8.

    CAS  PubMed  Google Scholar 

  154. Gong Y, Booser DJ, Sneige N. Comparison of HER-2 status determined by fluorescence in situ hybridization in primary and metastatic breast carcinoma. Cancer. 2005;103(9):1763–9.

    Article  CAS  PubMed  Google Scholar 

  155. Gong Y, Han EY, Guo M, Pusztai L, Sneige N. Stability of estrogen receptor status in breast carcinoma: a comparison between primary and metastatic tumors with regard to disease course and intervening systemic therapy. Cancer. 2011;117(4):705–13.

    Article  PubMed  Google Scholar 

  156. Xiao C, Gong Y, Han EY, Gonzalez-Angulo AM, Sneige N. Stability of HER2-positive status in breast carcinoma: a comparison between primary and paired metastatic tumors with regard to the possible impact of intervening trastuzumab treatment. Ann Oncol. 2011;22(7):1547–53.

    Article  CAS  PubMed  Google Scholar 

  157. Niikura N, Liu J, Hayashi N, et al. Loss of human epidermal growth factor receptor 2 (HER2) expression in metastatic sites of HER2-overexpressing primary breast tumors. J Clin Oncol. 2012;30(6):593–9.

    Article  PubMed  Google Scholar 

  158. Symmans WF, Ayers M, Clark EA, et al. Total RNA yield and microarray gene expression profiles from fine-needle aspiration biopsy and core-needle biopsy samples of breast carcinoma. Cancer. 2003;97(12):2960–71.

    Article  CAS  PubMed  Google Scholar 

  159. Gong Y, Yan K, Lin F, et al. Determination of oestrogen-receptor status and ERBB2 status of breast carcinoma: a gene-expression profiling study. Lancet Oncol. 2007;8(3):203–11.

    Article  CAS  PubMed  Google Scholar 

  160. Assersohn L, Gangi L, Zhao Y, et al. The feasibility of using fine needle aspiration from primary breast cancers for cDNA microarray analyses. Clin Cancer Res. 2002;8(3):794–801.

    CAS  PubMed  Google Scholar 

  161. Pusztai L, Ayers M, Stec J, et al. Gene expression profiles obtained from fine-needle aspirations of breast cancer reliably identify routine prognostic markers and reveal large-scale molecular differences between estrogen-negative and estrogen-positive tumors. Clin Cancer Res. 2003;9(7):2406–15.

    CAS  PubMed  Google Scholar 

  162. Sotiriou C, Powles TJ, Dowsett M, et al. Gene expression profiles derived from fine needle aspiration correlate with response to systemic chemotherapy in breast cancer. Breast Cancer Res. 2002;4(3):R3.

    Article  PubMed  Google Scholar 

  163. Tabchy A, Valero V, Vidaurre T, et al. Evaluation of a 30-gene paclitaxel, fluorouracil, doxorubicin, and cyclophosphamide chemotherapy response predictor in a multicenter randomized trial in breast cancer. Clin Cancer Res. 2010;16(21):5351–61.

    Article  CAS  PubMed  Google Scholar 

  164. Anderson K, Hess KR, Kapoor M, et al. Reproducibility of gene expression signature-based predictions in replicate experiments. Clin Cancer Res. 2006;12(6):1721–7.

    Article  CAS  PubMed  Google Scholar 

  165. Hess KR, Anderson K, Symmans WF, et al. Pharmacogenomic predictor of sensitivity to preoperative chemotherapy with paclitaxel and fluorouracil, doxorubicin, and cyclophosphamide in breast cancer. J Clin Oncol. 2006;24(26):4236–44.

    Article  CAS  PubMed  Google Scholar 

  166. Boeddinghaus I, Johnson SR. Serial biopsies/fine-needle aspirates and their assessment. Methods Mol Med. 2006;120:29–41.

    PubMed  Google Scholar 

  167. Fowler LJ, Lovell MO, Izbicka E. Fine-needle aspiration in PreservCyt: a novel and reproducible method for possible ancillary proteomic pattern expression of breast neoplasms by SELDI-TOF. Mod Pathol. 2004;17(8):1012–20.

    Article  CAS  PubMed  Google Scholar 

  168. Jeronimo C, Monteiro P, Henrique R, et al. Quantitative hypermethylation of a small panel of genes augments the diagnostic accuracy in fine-needle aspirate washings of breast lesions. Breast Cancer Res Treat. 2008;109(1):27–34.

    Article  CAS  PubMed  Google Scholar 

  169. Pu RT, Laitala LE, Alli PM, Fackler MJ, Sukumar S, Clark DP. Methylation profiling of benign and malignant breast lesions and its application to cytopathology. Mod Pathol. 2003;16(11):1095–101.

    Article  PubMed  Google Scholar 

  170. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90(18):1371–88.

    Article  CAS  PubMed  Google Scholar 

  171. Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999;340(2):77–84.

    Article  CAS  PubMed  Google Scholar 

  172. Rebbeck TR, Levin AM, Eisen A, et al. Breast cancer risk after bilateral prophylactic oophorectomy in BRCA1 mutation carriers. J Natl Cancer Inst. 1999;91(17):1475–9.

    Article  CAS  PubMed  Google Scholar 

  173. Masood S. Cytomorphology as a risk predictor: experience with fine needle aspiration biopsy, nipple fluid aspiration, and ductal lavage. Clin Lab Med. 2005;25(4):827–43, viii–ix.

    Google Scholar 

  174. Dooley WC, Ljung BM, Veronesi U, et al. Ductal lavage for detection of cellular atypia in women at high risk for breast cancer. J Natl Cancer Inst. 2001;93(21):1624–32.

    Article  CAS  PubMed  Google Scholar 

  175. Arun B, Valero V, Logan C, et al. Comparison of ductal lavage and random periareolar fine needle aspiration as tissue acquisition methods in early breast cancer prevention trials. Clin Cancer Res. 2007;13(16):4943–8.

    Article  PubMed  Google Scholar 

  176. Fabian CJ, Kimler BF, Zalles CM, et al. Short-term breast cancer prediction by random periareolar fine-needle aspiration cytology and the Gail risk model. J Natl Cancer Inst. 2000;92(15):1217–27.

    Article  CAS  PubMed  Google Scholar 

  177. Zalles CM, Kimler BF, Simonsen M, Clark JL, Metheny T, Fabian CJ. Comparison of cytomorphology in specimens obtained by random periareolar fine needle aspiration and ductal lavage from women at high risk for development of breast cancer. Breast Cancer Res Treat. 2006;97(2):191–7.

    Article  PubMed  Google Scholar 

  178. Arun B, Valero V, Liu D, et al. Short-term biomarker modulation prevention study of anastrozole in women at increased risk for second primary breast cancer. Cancer Prev Res (Phila). 2012;5(2):276–82.

    Article  CAS  Google Scholar 

  179. Sneige N, Liu B, Yin G, Gong Y, Arun BK. Correlation of cytologic findings and chromosomal instability detected by fluorescence in situ hybridization in breast fine-needle aspiration specimens from women at high risk for breast cancer. Mod Pathol. 2006;19(5):622–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yun Gong .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Gong, Y. (2013). Breast Cancer: Pathology, Cytology, and Core Needle Biopsy Methods for Diagnosis. In: Shetty, M. (eds) Breast and Gynecological Cancers. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1876-4_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-1876-4_2

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-1875-7

  • Online ISBN: 978-1-4614-1876-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics