How to Maintain the Quality of Aspiration Cytology for Breast Cancer

Abstract

The quality assurance of aspiration cytology for breast cancer in Japan currently lays behind that in Europe. The reason might be that in the United States of America during the last 30 years, aspiration cytology for breast cancer has been avoided by surgeons and cytologists because of medical lawsuit problems. Japanese doctors who were training in America during this period were effected by the social situation, and not by scientific opinion. We emphasize that accurate cytomorphological observation should be examined in more detail. American and Japanese cytology techniques for adenocarcinoma are rather simple and crude, for example, cytological diagnosis is done by the Papanicolaou criteria. However, Papanicolaou criteria for malignancy are set for degenerated squamous cell carcinoma, and not for aspirated fresh adenocarcinoma cells. Every cytological finding has to be investigated from the viewpoint of the degree to which it contributes to diagnosis. There is no absolute item important for smear evaluation. So, the important problem is how to find a combination of cytological criteria that leads to a better conclusion. Further research should be concentrated on this point. In addition, it should be discussed who has to do aspiration handling and make smear preparations. In some countries, surgeons take charge, whereas in other countries, cytologists aspirate and prepare smear specimens. The cytological results differ between the groups.