CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
How to offer same-day diagnosis
Shahla Masood, MD
May 2021—During the past several years, significant changes have occurred in the approach to the diagnosis and follow-up of patients with breast cancer. The scattered and fragmented breast health services have been replaced by patient-centered clinical breast units and rapid assessment breast clinics all over the world.1,2
Pioneered and implemented in European countries, rapid assessment breast clinics are designed to effectively assess symptomatic women with palpable breast lesions by fine-needle aspiration biopsy (FNAB). This approach reportedly has made early treatment planning possible for patients diagnosed with malignancy. More importantly, the prompt preliminary diagnosis has been associated with alleviation of anxiety for those patients with benign breast disease.3,4
Studies have shown that up to 87 percent of patients of rapid assessment breast clinics do not have cancer. Thus, there is no doubt that these clinics provide an incredibly important service in identifying those patients who do not need cancer therapy.5 The reports on the efficiency of rapid assessment breast clinics have shown a high level of patient satisfaction, improved delivery of care, and a reduction in the level of patient stress.6
To implement a successful rapid breast assessment clinic, it is critically important to secure the coordinated efforts of radiologists and pathologists so the right sampling procedure can be selected for patients. Aside from FNAB, a rapid assessment breast clinic must also consider the use of imprint cytology when the diagnosis of breast FNAB is equivocal, resulting in a follow-up core needle biopsy. In addition, the use of breast imprint cytology can be considered for effective immediate interpretation of image-detected biopsies.7 This approach will bring a benefit to the use of core needle biopsy in providing the same-day diagnosis. This is of particular importance since core needle biopsies are not amenable to immediate diagnosis, which rapid assessment clinics intend to provide8-10 (figure).
Rendering a pathology diagnosis by core needle biopsy requires 24 to 48 hours for fixation and tissue processing. In contrast, imprint cytology can be prepared in a few minutes by touching a biopsy sample on a glass slide, staining the imprint smear, and giving a preliminary diagnosis to the patient shortly after the biopsy procedure is completed. Imprint cytology is also helpful in assessing the adequacy of biopsy samples, minimizing the need for extra samples and repeated core needle biopsy procedures.8
The diagnostic accuracy of imprint cytology results depends on several factors, including the interpretive skills of the cytopathologist and the quality of the core biopsy, the imprint smears, and the staining. The reported average sensitivity and specificity indices for imprint cytology of core needle biopsy are 93 percent and 92 percent, respectively.11-15