Medical personnel who evaluate children for child abuse and neglect (CAN) must be familiar with the many pediatric conditions that resemble CAN in order to avoid over reporting. During a 3-year period, a total of 504 suspected child abuse patients were evaluated by our CAN team. After preliminary evaluation, 264 (52%) of these cases were unsubstantiated. Eighteen of these 264 (7%) were initially considered as cases of CAN but were later proven to be conditions that were misdiagnosed as CAN. Thirteen of the 18 (72%) were readily diagnosed after consultation with a pediatrician or other health care consultant. Investigation of the remaining 5 patients (29%) was more difficult and more extensive, requiring a period of separation from the parents with consequent emotional hardship to the family. These conditions included (1) a patient with osteogenesis imperfecta type IV, (2) a patient with Ehlers-Danlos syndrome, (3) two patients with benign external hydrocephaly of infancy, and (4) a patient with Crohn's disease, who was evaluated for sexual abuse because of chronic abdominal pain. A comprehensive literature review of pediatric conditions that may mimic CAN is presented by diagnostic categories to assist clinicians in differentiating medical conditions that may simulate CAN. Methods to support parents who have been incorrectly reported are discussed.

A prospective study was undertaken to evaluate the effectiveness of mammogram directed fine-needle aspiration cytology in women with nonpalpable abnormalities detected on mammogram. Seventy patients were entered into the research protocol, with 61 patients undergoing mammogram directed fine-needle aspiration. Forty-three of the aspirates were adequate for diagnosis. Fine-needle aspiration yielded an accurate diagnosis in 12 of the 14 carcinomas in which the sample was considered adequate, for a sensitivity of 87%. No patients were falsely diagnosed with malignant disease, a specificity of 100%. The predictive value of a positive test was 100%, and that of a negative test was 93%. We conclude that fine-needle aspiration cytology can aid in making a diagnosis when nonpalpable breast abnormalities are detected on mammogram.

A prospective study (protocol SG 89-150) was undertaken to determine the role of mammographically guided fine-needle aspirations in the diagnosis and subsequent surgical treatment of nonpalpable, mammographically detected breast cancers. During this study, once a diagnosis of cancer based on mammographically guided fine-needle aspiration was established, a wide segmental excision was performed to attempt to eradicate local disease. Surgical margins free of tumor were obtained in all cases. Total excision of these small lesions permitted in-depth histopathologic evaluation of the specimens. This led to the discovery that even the earliest detectable breast cancers may have extensive involvement of the surrounding breast tissue, which is vital information for planning complete therapy for the patient with breast cancer.