The role of breast FNA during and post‐ COVID‐19 pandemic: a fast and safe alternative to needle core biopsy

Pinto, Daniel; Schmitt, Fernando

The coronavirus disease 2019 (COVID‐19) has been very taxing to healthcare systems worldwide. As resources are diverted to treat COVID‐19, capacity for diagnostic and therapeutic procedures of other diseases is reduced, resulting in delays and waiting lists. This is particularly important in the context of oncology, namely breast cancer. All patients with suspicious breast lesions need pathological confirmation of malignancy in order to be treated; unfortunately, many of these procedures have been delayed. Nowadays these lesions are usually diagnosed using core needle biopsies (CNB). When compared to fine‐needle aspiration biopsies (FNAB), they are perceived to be more precise and provide better material for biomarker testing. However, FNABs are quicker to perform, less costly and minimally invasive, which would seem advantageous in the context of growing waiting lists. We would invite the reader to challenge their preconceptions of breast FNABs: not only have ancillary tests have been shown to be viable on both smears and cell blocks but, in 2019, the Yokohama System for Reporting Breast Fine‐Needle Aspiration Biopsy Cytopathology was developed and validated, enabling an accurate and reproducible categorization of breast lesions, significantly reducing the need for follow‐up CNBs. Thus, the major limitations of breast FNABs have been addressed. Furthermore, they are less invasive, leading to a lower risk of infection for personnel when standard biosafety procedures are followed. The right tool must be chosen for the right task. In the world of COVID‐19, FNABs may yet again prove a valuable and even essential diagnostic tool for symptomatic breast lesions.