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Introduction: In the year 2000 a quality assurance programme for the preoperative breast diagnostics was introduced in Denmark. The programme was based on the "European guidelines for quality assurance in breast cancer screening and diagnosis" where - among other measures - five cytological diagnostic classes were introduced. The aim of this study was to evaluate the quality assurance programme in a screening population to determine whether fine needle aspiration cytology (FNAC) as first choice remains a useful tool in the preoperative diagnostics, or if needle core biopsy should be the first-choice treatment., Material and Methods: 767 women had FNAC performed from a total of 783 lesions at the Mammography Clinic, University Hospital Odense. All FNACs were compared with the final histology diagnosis. Nine statistical parameters were calculated according to the European guidelines., Results: A total of 66% of the 783 FNACs had a malignant cytology diagnosis, which in 99% of the cases turned out to be the correct diagnosis. Four lesions were false positives all of which represented benign proliferative breast diseases. The surgical procedures in these cases were either excisional biopsy or lumpectomy. The values of eight of the nine mutually dependent statistical parameters of quality scored within the recommended threshold values. Specificity was the only parameter that fell outside the recommended threshold values., Conclusion: Although specificity in our study is lower than recommended, we find that the use of FNAC as first-choice in triple diagnostics is a useful tool.

The golden standard in non-operative breast cancer diagnosis is the triple test, a combination of clinical evaluation, mammography/ultrasound and needle biopsy, either fine needle aspiration cytology (FNAC) or histological core biopsy. FNAC and core biopsy both have advantages and disadvantages but neither of them can act as a decisive diagnostic procedure on its own. The final diagnosis should always be a consensus between the three diagnostic modalities in the triple test. Quality assurance of the pathological diagnosis is a must. The number of uncertain diagnoses i.e. atypia or suspicion of malignancy should be kept at a minimum. These diagnostic categories call for additional diagnostic procedures and thereby cause a delay in reaching the final diagnosis leading to definitive treatment.

Fibroadenoma is the third most frequent palpable phenomenon in the breast in women and is most often seen around the age of 30. The size varies but is in average between one and three centimeters. Fibroadenomas originate from a breast lobule and can be situated anywhere in the breast. The ethiology is uncertain but it seems as if hormonal factors play a role. Investigations have shown that many of the fibroadenomas decrease in size and even more regress. The traditional treatment of fibroadenomas is excision but a conservative treatment seems to be reasonable. We conclude that fibroadenomas in adolescents can safely be treated conservatively after having been examined by an experienced breast surgeon. In adult women a benign triple test is a prerequisite for conservative treatment.