Performance of fineneedle aspiration cytology of the breast. Clinical experience in Ravenna (Italy)

Aims and background: Fineneedle aspiration cytology (FNAC) is a routine test in the evaluation of breast lesions. We assessed the diagnostic accuracy of mammography (MG), physical examination (PE), ultrasonography (US) and FNAC in 1064 histologically confirmed breast lesions (638 malignant, 426 benign) observed consecutively at the Cancer Prevention Center of Ravenna (Italy). Methods: The performance of each test and the additional contribution of FNAC were determined. Results: FNAC was done in 69.6% of cancers and 39.7% of benign lesions (P = 0.00000), the frequency of aspiration being significantly associated with severity at MG, PE, and US. For FNAC, the true positive rate was 95.1% and the true negative rate 67.4%. Only one breast cancer case was detected by FNAC alone (additional true positive rate 0.2%). The positive predictive value of FNAC in the absence of other abnormalities was 5%. The negative predictive value of a benign report at MG, PE, US and FNAC was 100%. Conclusions: All breast lesions should be evaluated by all available techniques, especially FNAC, and open biopsy should be avoided for those reported as benign at all tests.