Breast FNAC - Probabilistic approach

Breast FNA is more sensitive and specific for malignant neoplasms than for borderline or benign lesions. A diagnostic approach based on the probability of identifying malignancy in a breast is therefore more clinically appropriate. This has been termed the probabilistic approach to the diagnosis of carcinoma.

Five diagnostic categories are defined

1) Positive for carcinoma

all four of the following must met:

Cellular dyshesion
Cytological atypia
Single cell population
Hypercellularity

2)Suspicious for carcinoma

When any three of the above four features are present

3)Epithelial proliferative lesion with atypia

when the specimen in cellular with many epithelial cells and when epithelial cells present in groups and show significant crowding and overlapping and/or specimen shows one other feature of malignancy out of above four.

4) Epithelial proliferative lesion without atypia

when specimen is cellular with many epithelial cell and the epithelial cells in groups show no or mild crowding and overlapping, with obvious myoepithelial cells present and no other features of carcinoma.

5) Unremarkable

when none of the four features of malignancy is present