I n this issue of Cancer Cytopathology, Drs. Boerner and Sneige 1 propose that aspirate samplings with fewer than six epithelial cell clusters be considered nondiagnostic. In their opening remarks they correctly note that among experts "there is no agreement on whether the presence of epithelial cell clusters (ECCs) in aspirates of solid breast masses is necessary" and cite articles by Stanley et al. 2 and Layfield et al. 3 The article by Stanley et al., which we recommend highly, asks an expert panel to express their points of view on what constitutes cell content adequacy in the context of triple benign diagnosis. One group cited a varied array of differing cell counts as a measure of adequacy. The other group interwove the combined features of cytologic, clinical, and mammographic findings of the breast nodule to determine adequacy. Because of their multiparameter approach, we describe this latter group as "clinical cytopathologists," and consider ourselves part of that group.
The article by Layfield et al. also purports to show the benefits of cell counting; however, when their data were reviewed and two significant biases removed, there was no significant difference in falsenegative rates regardless of whether cell counts were invoked. 4 In this editorial we present our perspective as clinical cytopathologists on the fine-needle aspiration (FNA) of palpable breast nodules. We explore what histopathologic features in the target nodule contribute to the presence of cells on a slide, examine details of FNA reporting, evaluate the legal issue of standard of care (SOC) as it pertains to FNA diagnosis, calculate the potential impact should numeric cell counts become mandatory, and review the features of adequacy put forth in the Bethesda Breast Conference (BBC) of 1996. 5 Having established that background, we will conclude by analyzing the article by Boerner and Sneige and the concerns raised by its authors.
The number of cells on a slide from an FNA of a palpable breast