Atlas of breast cancer early detection

The principles and practice of cytopathology in breast lesions are based on the study of the morphological features of the cells in the lesion. The specimens from the breast that may require cytological evaluation include:

• aspirated materials from palpable and non-palpable breast lesions (FNAC);
• nipple discharge; and
• nipple or skin scrapings.

FNAC is the most commonly performed cytological evaluation for suspected breast pathologies and we will discuss the procedure in detail in the following sections. Secretions from the nipple can be smeared on a slide by a simple touch preparation. A clean glass slide is applied to the nipple to collect the secretion and a smear of the fluid is prepared. The slide containing the smear is then fixed with 95% ethanol and stained with Papanicolaou (Pap) stain. Alternatively, the smear may be air-dried and stained with Giemsa stain. Scrape smears are prepared from eczematous nipple–areolar complex lesions, such as suspected Paget disease of the breast, by touching the glass slide to the weeping lesion or scraping the scaly lesion. The smears are then fixed and stained according to the routine procedure.

We have described the indications and the steps used to perform FNAC under ultrasound guidance in earlier sections.