Paja-Perušić, Dubravka

Vlaisavljević, Veljko

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Radio/ Oncol 1994; 28: 134-7. Breast tumor aspiration biopsy with a multihole needle Veljko Vlaisavljevic1 and Dubravka Paja-Perušic2 1 Department of Gynecology, 2 Department of Pathology, Maribor Teaching Hospital, Maribor, Slovenia In 36 patients, breast tumors or palpable breast masses were punctured with a standard fine needle and a multihole needle. Equal quality of cel! material for cytologic investigation was found with both methods, but a significantly larger quantity of material was aspirated (in punctures) using the mul tiho le. Key words: breast neoplasms - methodology; biopsy, needle; cytology, aspiration biopsy, technique Introduction Breast tumor aspiration with a fine needle is a routine method without which it is difficult to organize the complete diagnosis of breast dise­ases. According to the data from the review article by Us-Krašovec et al. (1982), the percen­tage of correct diagnoses in breast cancer obtai­ned by cytologic analysis of aspirates ranges from 77-92.3 % . The percentage of false posi­tive (0.2-1.6 % ) and false negative (3.2-11.5 % ) results is within sufficiently low limits. Similar results were also registered at our insti­tution.1 A serious drawback of cytologic diagnosis is a problem which is often not within the power of the cytologist to solve: (not enough) insuffi­cient quantity of diagnostically relevant mate­rial. The cause may lie in inadequate collection or poor preparation of biopsy specimens, in Correspondence to: Veljko Vlaisavljevič, M. D., Ph. D., Department of Gynecology, Maribor, Teac­hing Hospital, Ljubljanska 5, 62000 Maribor, Slovenia. UDC: 618.19-006.6-076 greasy plates preventing fixation of specimens, or in the nature of the punctured lesion itself. This is often the case in cyst aspirates where there is little celi material, or in scirrhous carcinoma aspirates where the presence of the epithelial component of tumor is minimal. Thus, various authors report on 3.3-7.9% of unsuccessful biopsies among carcinomas and on a significantly larger share among benign breast lesions (9.0-24.1 %). L-4 Aspiration biopsy of the suspicious breast area presents a special problem when there is no palpable tumor. Increased nodosity is not always the result of proliferation of the glandu­lar component of breast tissue. The amount of glandular tissue varies strongly with regard to breast type and the woman's age. In premeno­pause it amounts up to 20 % , in postmenopause only up to 2 -5 % . In this period of tirne the share is fatty (50-70 % ) and connective tissue (30--40 % ) is prevailing. Such transformation of the breast makes collection of representative cytologic samples for analysis difficult. The aim of our study was to compare the success of puncture using a fine needle - fine Breast tumor aspiration biopsy with a multihole needle 135 needle aspiration cytology (FNAC) with that using a needle with severa! openings - multihole needle aspiration cytology (MHNAC). This would offer a greater possibility of obtaining an aspirate from a correct site and in a sufficient amount. The needle was made in the needle factory in Kobarid (TIK) according to descrip­tion from literature. 5 Some authors report that by using a fine needle with severa! side openings (a multihole or MH needle) they obtain more celi material for analysis and get better diagnostic results (5). It was our aim to establish whether biopsy specimens obtained by puncture with a MHneedle contain an equal, larger or smaller amount of celi material than specimens obtain­ed with a standard fine needle. Material and rnethods The multihole needle was made for research purposes in the TIK factory. For its fabrication a standard disposable needle was used, with three additional openings made at its <listal end. Two openings were on the same leve! and one was on the opposite side. � c::::) c:) g The technique of aspiration using the MHneedle was identical to that used in punctures with the fine needle. Since we were comparing the quality of smears obtained with two diffe­rent needles, each lesion was punctured in the same manner through the same needle insertion site. Before puncture, the skin was disinfected. The first puncture was done with a fine needle. A Cameco puncture pistol and a 10 ml syringe were used. The contents of the lesion were aspirated while moving the needle forwards and backwards in different directions through the lesion and simultaneously rotating the syrin­ge. Then the puncture was continued with a MH needle. It was introduced through the same insertion point and the same puncture technique was used. The aspirate was squirted onto a specimen plate and larger pieces of tissue were crushed with the needle. Celi material obtained by aspiration puncutre was smeared on 2-3 specimen plates, fixed and stained in the cytological laboratory according to three staining methods: May Gri.inwald­Giemsa, Papanicolaou and hematoxylineosin. Every pathologic process which could be lo­calized, irrespective of whether it was suspicious or not, presented an indication for aspiration puncture with a fine needle. The cytologic findings were classified into negative, suspicious and positive. Negative cy­tologic findings mean the presence of normal glandular epithelium of the breast with or with­out cellular atypia and the presence of cells of benign breast dysplasia. Cytologic findings are considered suspicious when according to their morphology and their distribution the cells give the impression of a malignant process, and for certain reasons the cytologist cannot take the responsibility for the subsequent radical therapy. Positive cytologic findings mean the presence of malignant cells in the smear of the tumor biopsy specimen. Biopsy specimens with little or insufficient celi material for cytologic investigation are rath­er questionable. In view of the fact that cyto­diagnosis is a subjective diagnostic method, it is often difficult to determine the limit at which the aspirate is stili adequate for investigation and to decide whether a certain number of cells in the aspirate stili gives a sample representative for cytologic investigation. In cytologically ne­gative findings with little cell material it is therefore difficult to determine whether they really are negative, taking into account that a high percentage of false negative findings can follow as a result of misinterpretation. In such cases a repeated puncture and follow-up investi­gation are recommended. Statistical significance was tested with the chi-sq uare test. Results and discusion In our Breast Diagnostic Center, 37 MHNAC and 41 FNAC were carried out in 36 patients. 136 Vlaisavljevic V and Paja-Perušic D In 30 patients the same tumor was punctured with a fine and with a MH needle, in 6 patients the puncture was carried out only with the MH needle; 1-4 punctures were done in each pa­tient. In FNAC, the number of aspirates with an insufficient amount of celi material was larger (n = 18) than in punctures with the MH needle (n = 13), but in specimens obtained with FNAC, the number of positive cytologic find­ings was larger (n = 7) than in those obtained with the MH needle (n = 5). In both groups the difference was not statistically significant. These two positive cytologic results in aspirates obtain­ed with FNAC we suspicious in aspirates with the MH needle (in one case the amount of celi material in the sample was smaller, in the second case the celi material was less represen­tative - probably obtained by puncture from the tumor margin). The number of suspicous specimens was the same with both types of needle (n = 7). Negative findings were observed more frequently in MH needle group (n =12 vs. 9) In 30 patients the cytologic findings and the quantity of celi material obtained by FNAC and MHNAC were compared. In one third of our cases (10 out of 30) an approximately equal quantity of celi material was found, meaning that the celi sample was equally representative in aspirates with the stan­dard fine needle and with the MH needle. A more representative cell sample was also found in about one third of cases in aspirates obtained with the MH needle (8 out of 30) and in those obtained with the fine needle (12 our of 30). Factors affecting the sensitivity of FNAC of the breast include the aptitude of the aspirator, the experience of the cytopathologist, the size of the lesion and certain histological cancer types. By means of MHNAC we wished to improve the sampling of the punctured lesions. We assumed that the quantity of the material would be larger while the number of inadequate sam­ples would be smaller. This would enable safer application of aspiration cytology for the final definition of benign lesions and conservative treatment of benign tumors. Today numerous authors speak in favour of a second benign FNAC sample before patients with palpable benign lesions can meet the crite­ria for conservative management.6 The reason for this lies above all in the possibility of avoiding the risk of inadequate sample collec­tion in eventual carcinoma. We believe that the described technique can bi particularly successful in ultrasonically quid­ed punctures as well as in punctures of benign palpable breast masses. Conclusion The comparison of puncture biopsy specimens obtained with the standard fine needle and the MH needle revealed approximately equal qua­lity of celi material for cytologic investigation. The quality of the celi material itself did not differ essentially, in spite of the fact that a significantly larger quantity of material was obtained using the MH needle. It would only be possible to assess the value of MHNAC on the basis of a study comprising a larger number of aspirates from palpable and nonpalpable breast lesions. Acknowledgement The author wishes to thank Marijana Gajšek­Marchetti, translator at the Medical Research Department, for her contribution in translating the manuscript. References l. Paja-Perušic D. Aspiracijska citologija v diagnostikibolezni dojk. Zbornik mariborskega ginekološko­porodniškega srečanja, Maribor, 1982: 61-8.2. Us-Krašovec M, Golouh R, Lamovec J. Aspiracij­ska biopsija tumorjev dojke. Zdrav Vesin 1982: 51:549-53.3. Vlaisavljevic V, Paja-Perušic D, Gorišek B, Rauterz. Ciste dojke - dijagnostika i liječenje. Jugosl Ginekol Perinatol 1985; 25: 125-8.Breast tumor aspiration biopsy with a mu/tihote needle 137 4. Ciatto S, Cariaggi P, Bulgaresi P, Confortini M,Bonardi R. Fine needle aspiration cytology of the breast: review of 9533 consecutive cases. Breast1993; 2: 87-90.5. Yorhererr H. Breast aspiration biopsy with multi-hole needles for histologic and cytologic examina­tion. Am J Obstet Gynecol 1985; 151: 70-6. 6. Paraskevoupoulos J, Newton L, Stephenson T,Shorthouse A. Breast audit: a second fine needleaspiration cytology is advisable to exclude malig­nancy. Breast 1993; 2: 91-2.

Breast tumor aspiration biopsy with a multihole needle

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Breast tumor aspiration biopsy with a multihole needle

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