Modified core wash cytology (CWC), an asset in the diagnostic work-up of breast lesions

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Abstract

Aim

A quick and reliable preliminary diagnosis is essential in the management of a same-day breast clinic. In a preclinical study we developed an alternative method of core wash cytology (CWC). This study is an evaluation of this new CWC method introduced into the clinical setting.

Methods

From April 2008 to April 2009, biopsies were taken from lesions in the breast. CWC was obtained from core needle biopsy (CNB) with a modified technique and classified into the categories: malignant, suspicious for malignancy, atypical, benign and inadequate. CWC and CNB diagnoses were correlated with the histopathology of subsequently obtained resection specimens. The sensitivity and specificity were calculated.

Results

CWC was obtained from 226 breast lesions. In 167 of these cases subsequent resection of the lesion was performed revealing 149 carcinomas and 18 benign lesions.

Of the 149 malignant cases, 136 were considered as either malignant or suspicious for malignancy by CWC, 7 as atypical, 4 as benign and 2 as inadequate. None of the 18 benign lesions were classified as suspicious or malignant on CWC. Eight out of 149 resected carcinomas were not recognized as malignant by histological analysis of the CNB, while 7 of these cases the CWC was considered malignant. The sensitivity and specificity were 97% and 100%, respectively.

Conclusions

In the vast majority of patients the modified CWC technique can provide a quick and reliable diagnosis of malignant breast lesions. Furthermore, combining CWC with CNB histology can improve adequate, preoperative recognition of the malignant character of breast lesions.

Introduction

The core needle biopsy (CNB) is increasingly being used as a first-line diagnostic modality in the diagnostic work-up of palpable and non-palpable breast lesions. Indeed, histological examination of such biopsies generally provides very important and detailed information about tumour characteristics, including subtype of carcinoma, hormonal status and other molecular features.

However, a same-day breast clinic requires a quick and reliable diagnosis for same-day patient counselling and optimal planning of further surgical or neo-adjuvant management. In most laboratories, a CNB diagnosis takes 12–24 h of processing. Core wash cytology (CWC) or touch imprint cytology (TIC) could be a solution for this problem because by cytological analysis a diagnosis can often be rendered within 1 h. Unfortunately, the results described in the literature with such cytological diagnostic approaches are variable. In studies on CWC the sensitivity and specificity varied from 85% to 89% and 72% to 98%, respectively, while the inadequate rate varied from 7% to 42%.1, 2 Studies on TIC showed variable results as well.3, 4, 5, 6, 7, 8, 9, 10

We developed a modified CWC technique in which the collecting fluid is optimized and the processing is standardised. This technique was first tested in a laboratory setting and yielded very promising results, especially in malignant lesions.11 We then introduced the CWC approach into the clinical setting.

In this manuscript we present the results obtained in the first year after the introduction of the modified core wash technique.

Section snippets

Patient and tissues samples

From April 2008 to April 2009, CNBs were taken from palpable and non-palpable lesions in the female breast in our teaching hospital. According to the Breast Imaging Reporting and Data System (BI-RADS), developed by the American College of Radiology, biopsies were taken by the radiologist. Two to 3 CNBs per lesion were obtained by radiologists, using an18 gauge needle (Bard Peripheral Vascular, Inc., Tempe, Arizona USA) and biopsy gun under ultrasound guidance.

CWC technique

The biopsies were collected in 6 ml

Patients and pathological findings

In a one year period (April 2008–April 2009), CWC was obtained from the CNB of 226 breast lesions. The age of the patients ranged from 21 to 92 years (median 57,5 years). In 167 of these cases subsequent resection of the lesion was performed in the follow-up.

Malignant cases

The resection specimens revealed 149 carcinomas (ductal n = 111, lobular n = 24, DCIS n = 7 (one grade 2 and 6 grade 3), mucinous n = 4, tubular n = 1, medullary n = 1, papillary n = 1).

Of the 149 malignant cases, by CWC 136 cases were

Management breast clinic

For optimal organization of a same-day breast clinic a quick and reliable pathological diagnosis is warranted. A histological diagnosis in 1 h, at all times of the day, would be the best but is until today not available. Touch imprint cytology (TIC) or core wash cytology (CWC) could be a solution in a same-day breast clinic, but variable results were described for both techniques in the literature. A recent study on TIC revealed a sensitivity and specificity of 97.7% and 94.2%, respectively.10

Conclusion

We conclude that, combining CNB with CWC analysis for the initial diagnostic work-up of breast lesions has some clear advantages: 1. The modified CWC technique can provide a quick and reliable diagnosis of (especially malignant) breast lesions, which is valuable for same-day patient counselling and management planning; 2. Combining CWC with CNB findings can lead to an increase in the number of adequate preoperative diagnoses of malignancy in breast lesions.

Conflict of interest

No author has had any financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work.

Acknowledgements

The authors gratefully acknowledge the excellent technical support of Mrs. Chantal Huyben-van Leent for this study.

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