• breast cancer
• fine needle aspiration
• core biopsy
• cytology

Shannon and colleagues¹ conclude that conversion to core biopsy increases sensitivity and specificity and reduces the inadequate rate, and advocate the abandonment of fine needle aspiration (FNA) in the preoperative diagnosis of breast disease.

In their experience, the inadequate rate for FNA in the symptomatic breast disease context of 35% is certainly untenable, but it would be appropriate to evaluate the application of the technique rather than the technique itself. The authors provide no data on the structure of their FNA service: were the aspirates performed by a limited number of trained and experienced aspirators? What indications were considered appropriate for FNA? Was there rapid assessment of FNA with repeat of inadequate samples?

An additional factor may be the technique used: 21 gauge needles are very large bore for symptomatic breast FNA, and better results can be obtained with smaller gauge needles (23 gauge),² whereby discomfort is reduced, blood contamination is reduced, and cell yield is satisfactory.

The structure of a service where the inadequate rate of FNA is as high as 35% must be seriously questioned. In our experience in symptomatic breast disease practice, the use of FNA within a triple assessment context complemented by core biopsy in situations of significant discordance between modalities is a robust and …