MAMMOGRAPHICALLY GUIDED FINE-NEEDLE ASPIRATION CYTOLOGY OF THE BREAST- REDUCING THE RATE OF INSUFFICIENT SPECIMENS

OBJECTIVE. The purpose of our study was to reduce the rate of insuffic ient specimens from fine-needle aspiration cytology (FNAC) of impalpab le mammographically detected breast lesions. SUBJECTS AND METHODS. Our previous rate of insufficient specimens for FNAC was 27%. We implemen ted the following strategies to reduce this rate and improve accuracy: retraining of radiologists in FNAC procedures, more vigorous sampling , on-site evaluation of specimens by cytopathologist or cytotechnologi st, exclusive use of stereotaxic guidance, stereotaxic equipment calib ration program, and verification of initial needle placement. RESULTS. Of 77 patients with impalpable abnormalities who underwent FNAC with the new protocol, six (8%) had insufficient specimens for cytologic di agnosis: Four were incorrectly judged to contain sufficient material a t the time of FNAC, one refused to complete the FNAC, and one had a va sovagal reaction, Of the six cases with insufficient specimens, four w ere benign at biopsy, one was malignant, and one was determined to be benign on the basis of mammographic stability. CONCLUSION. Modificatio n of techniques and implementation of a quality assurance program can significantly improve the insufficient specimen rate for FNAC. Correla tion of mammographic and cytologic findings also improves the manageme nt of these cases.