Impact of inadequate fine-needle aspiration cytology on outcome of patients with palpable breast lesions

Background: The purpose of the present study was to assess the impact of inadequate fine-needle aspiration cytology (FNAC) breast specimens on the outcome of patients with a palpable breast lesion. Methods: A retrospective review was carried out of inadequate FNAC specimens from the Department of General Surgery, Singapore General Hospital in 1997. Results: One hundred and thirty-eight (16.6%) of 831 FNAC specimens were reported inadequate, and these form the study group. Outcome analysis was divided into benign on excision biopsy (n = 38; 29.4%); benign on repeat FNAC or trucut biopsy (n = 6; 4.7%); benign on follow up (n = 46; 35.7%): malignant on histology (n = 11; 85%); and lost to follow up (n = 28: 21.7%), The 11 cases with breast cancer were further analysed. The mean time to treatment was 88.3 days for three patients whose tumours were not clinically suspicious of malignancy versus 20 days for six patients who were diagnosed with cancer clinically from the onset. One patient with cancer refused treatment and one absconded from treatment only to return 7 months later, Conclusion: Breast cancer was present in 8.5% of the inadequate FNAC specimens. When clinical suspicion of malignancy is high, an excision biopsy is advised in patients with inadequate FNAC specimens. If properly managed with triple tests and good clinical judgement, the inadequate FNAC specimens do not delay treatment in patients with breast cancer.