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.

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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.

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