FINE-NEEDLE ASPIRATION (FNA) CYTOLOGY OF THE BREAST - THE INFLUENCE OF UNSATISFACTORY SAMPLES ON PATIENT-MANAGEMENT

FNA continues to play an important role in the management of patients with breast lesions, However, the reliability and efficiency of the FN A service depends heavily on the quality of the specimens. We have aud ited the rate of 'inadequate FNAs' at intervals over the last 5 years and related our findings to the clinical expertise of the aspirator. W e have also correlated the rate of inadequate FNAs with the percentage of patients who had an FNA preceding a definitive diagnosis of cancer . We report trends in the rate of inadequate samples, and subsequent d iagnosis of cancer, over a 5-year period. The percentage of breast FNA samples reported as inadequate was 46.8% in 1988-89. falling to 20% i n in 1991-92 with the introduction of an FNA clinic, and rising to 30. 6% in 1993. The rates of cancer following inadequate FNA were 15.7%, 1 6.1% and 4.2%, respectively, and the percentage of patients with cance r having a preceding inadequate FNA were 37.5%, 13.2% and 7.1%. Possib le explanations for the apparent paradox between increasing numbers of inadequate FNA specimens and a falling breast cancer rate are discuss ed.