EUROPEAN DISCUSSION FORUM DOI:10.1111/j.1365-2303.2008.00610.x The role of breast FNAC in diagnosis and clinical management: a survey of current practice G. Kocjan*, C. Bourgain   , A. Fassina à , B. Hagmar § , A. Herbert – , K. Kapila**, I. Kardum- Skelin    , V. Kloboves-Prevodnik àà , S. Krishnamurthy §§ , H. Koutselini –– , B. Majak***, W. Olszewski     , B. Onal ààà ,Z ˇ . Pohar-Marins ˇek §§§ , I. Shabalova ––– , J. Smith****, E. Tani      , P. Vielh àààà , H. Wiener §§§§ , U. Schenck –––– and F. Schmitt ***** *Department of Histopathology, University College London, London, UK,   Department of Pathology and Centre for Reproductive Medicine, Brussels, Belgium, à Department of Pathology, Univeristy of Padova, Italy, § Department of Pathology, Rikshospitalet, Oslo, Norway, – Department of Pathology, St ThomasÕ Hospital, London, UK, **Department of Pathology, Univeristy of Kuwait, Kuwait,    Cytology Laboratory, Bolnica merkur, Zagreb, Croatia, àà Institute of Oncology, Ljubljana, Slovenia, §§ MD Anderson, Houston, TX, USA, –– Greek Society of Cytology, ***Telemark sentralsjukehus, Porsgrunn, Norway,     Department of Pathology, Institute of Oncology, Warsaw, Poland, ààà Turkish Cytology Society, §§§ Department of Cytopathology, Institute of Oncology, Ljubljana, Slovenia, ––– Russian Cytology Society, ****Royal Hallmshire Hospital, Sheffield, UK,      Karolinska Hospital, Stockholm, Sweden, àààà Institut Gustave Roussy, Department of Pathology, Villejuif Cedex, France, §§§§ Klinisches Institut fu ¨ r Pathologie, Medizinische Universita ¨ t Wien, Vienna, Austria, –––– Institute of Pathology, Technical University, Munich, Germany and *****IPATIMUP and Medical Faculty of Porto University, Porto, Portugal Accepted for publication 31 July 2008 The role of breast FNAC in diagnosis and clinical management: a survey of current practice Most participating countries have now adopted a triple assessment approach, i.e. clinical,imaging and pathology, to breast diagnosis, with FNAC as the first-line pathological investigation in both screening and symptomatic populations, with the exception of microcalcifications. Pathologists specialized in cytopathology are best qualified to collect and interpret FNAC samples, but this is not always possible or practical. Radiologists involved in breast imaging should ensure that they have the necessary skills to carry out FNAC under all forms of image guidance. Best results are achieved by a combination of both techniques, as shown in the image-guided FNAC in the presence of the cytopathologist. The majority of European countries use similar reporting systems for breast FNAC (C1–C5), in keeping with European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis, although some still prefer descriptive reporting only. When triple assessment is concordant, final treatment may proceed on the basis of FNAC, without a tissue biopsy. ER and PR assessment can be done safely on FNAC material. However, not all institutions may have expertise in doing this. HER-2 protein expression on direct cytological preparations is insufficiently reliable for clinical use, although its use for FISH is possible, if expertise is available. The majority of participants practise a degree of one-stop diagnosis with a cytopathologist present in the out-patient clinic. Formal recognition of the importance of the time spent outside the laboratory, both for cytopathologist and cytotechnologist, is necessary in order to ensure appropriate resourcing. The use of core biopsy (CB) has increased, although not always for evidence-based reasons. CB and FNAC are not mutually exclusive. FNAC should be used in diagnosis of benign, symptomatic lesions and CB in microcalcifications, suspicious FNAC findings and malignancies where radiology cannot guarantee stromal invasion. Keywords: breast cancer, breast diagnosis, breast management, breast cytology, FNA, core biopsy Fine needle aspiration cytology (FNAC) has been extensively used for many years in the diagnosis of breast lesions, but its use has gradually been reduced in many screening programmes because of its controver- sial inadequate rates and suboptimal accuracy in inex- perienced hands. 1–3 The aim of this review is to explore Correspondence: G. Kocjan, Department of Histopathology, University College London, Rockefeller Building, London WC1E 6JJ, UK Tel.: 0207 679 6025, Fax: 0207 679 6324; E-mail: g.kocjan@ucl.ac.uk Cytopathology 2008, 19, 271–278 ª 2008 The Authors Journal compilation ª 2008 Blackwell Publishing Ltd 271