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FNAC (Fine needle aspiration cytology)

Benefits:

• FNAC (Fine needle aspiration cytology) from breast mass: sensitivity 95% & specificity 98%.

However, it should not be used for diagnosing lymph node metastasis (only excisional biopsy). One drawback of FNAC is that it cannot differentiate between invasive and insitu cancers as only cells are seen and the architecture cannot be evaluated as in biopsies. Aspiration of a simple benign breast cyst should yield non-bloody fluid and result in complete resolution of the lesion.

Ultrasound /  stereotactic core biopsy

This technique is helpful in cases where there are findings in the mammography. A wire or needle guided lumpectomy can follow this procedure.

Benefits

• Wide-bore needle biopsy is less sensitive but more specific when compared to FNAC (specificity 100%)

Excisional biopsy

An excisional biopsy, in which the entire breast mass is removed, definitively establishes the diagnosis. When the mass is extremely large, an incisional biopsy (which entails removal of only a portion of the mass) may be more appropriate.

• Specificity of 100%.

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Ductal lavage

Ductal lavage is currently being developed and analyzed as a minimally invasive tool to identify cellular atypia within breast ducts in women who are already at high risk for developing breast cancer. Preliminary results indicate that this method has a low sensitivity and specificity (Journal of the National Cancer Institute 2004;96:1488-1489,1510-1517).

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