The reliability of the cytological diagnosis in a breast cancer clinic

The reliability of the cytological diagnosis in a breast cancer clinic The characteristics of a FNA smear are influenced by a number of factors including the nature of the tissue in question, the aspiration, smearing and staining techniques, in addition to the experience of the aspirator and cytologist. Reluctance to accept cytology reports as the basis for definitive treatment has been explained by their ambiguity and lack of standardisation of terminology. A number of studies have shown that sensitivity, specificity and positive predictive value are higher and inadequacy rates lower when the FNA is performed by the pathologist as opposed to the clinician. Controversial issues may be summarised as follows: specimen adequacy; false negative (FN) diagnoses; false positive (FP) diagnoses; distinguishing between ductal carcinoma in situ (DCIS) and invasive carcinoma; distinguishing between DCIS and atypical ductal hyperplasia; the degree of accuracy required of the cytopathologist to ensure appropriate treatment of the patient. Performance requirements have been described by both the British and the Norwegian Breast Cancer Screening Programmes and it has been shown that both the preliminary diagnosis given at the one-stop breast clinic and the final diagnosis meet these requirements. Several attempts have been made to construct systems that select the cytological features in a smear capable of predicting the diagnosis using image analysis, statistical methods and neural network technology. The most important effect of these studies is the resultant awareness among cytologists of the importance of a systematic, well documented assessment of the smear. They also confirm that the cytological diagnosis is anchored in reproducible morphological criteria similar to the histopathological diagnostic process. In all breast clinics the basis on which the final diagnosis is given must be clearly understood by both the clinician and the pathologist and a description of the characteristics of the material upon which the diagnosis is given should be an integral part of the cytology report.