Random fine needle aspiration of the breast of women at increased breast cancer risk and standard risk controls

The diagnosis of occult breast epithelial proliferation by random fine needle aspiration biopsy (FNAB) of the breast remains controversial. However, the detection of proliferative change using FNAB would potentially improve assessment of breast cancer risk among women entering chemoprevention trials. To assess the validity of this procedure in risk stratification for breast cancer, we performed FNAB on 70 women while they were anesthetized for a variety of general surgical procedures. The contralateral breasts of 32 women with a history of breast cancer (cases) and both breasts of 38 women at standard risk for breast cancer (controls) were subjected to random FNAB. Cytospin preparations from four pooled FNAB passes from each breast were stained by the Papanicolaou technique and interpreted according to previously published criteria. Inadequate aspirates comprised 40% (28/70) of the samples. In the remaining cases, there was a statistically significant difference between the frequency of proliferative changes and atypical hyperplasia in high-risk cases versus controls (Pearson χ² = 9.98, p = 0.019). The contralateral breasts of women with sporadic breast cancer demonstrated proliferative changes at higher rates than breasts of asymptomatic control women. Similarly, in a logistic regression model, the odds of a diagnosis of breast cancer increased with the presence of proliferative changes with or without atypia [odds ratio (OR) = 3.6, p < 0.02]. This study suggests that FNAB may have a role in the further stratification of high-risk women and provide a suitable sample for the monitoring of surrogate end point biomarkers in chemoprevention trials.