Prospective evaluation of radiologically directed fine-needle aspiration biopsy of nonpalpable breast lesions

Abstract

The application of fine-needle aspiration biopsy (FNAB) to the diagnosis of nonpalpable breast lesions was evaluated with a new method which uses standard needle localization under mammographic guidance to assure accurate sampling by FNAB. This method was prospectively applied to 100 mammographically detected breast lesions in 100 women (mean age, 53 years). All 100 patients underwent surgical excision of these nonpalpable lesions after cytologic aspiration. Sufficient aspirated material was obtained for cytologic diagnosis from 91 patients (91%). The histologic and cytologic interpretations were then compared. Twenty malignancies were ultimately diagnosed by histology (12 invasive ductal carcinoma, six ductal carcinoma in situ, and two lobular carcinoma in situ), of which 17 had been cytologically diagnosed. There were no false-positive diagnoses of malignancy by FNAB. False-negative readings (3.3%) included two cases of lobular carcinoma in situ and one case of ductal carcinoma in situ. This technique thus demonstrated a sensitivity of 85%, specificity of 100%. and overall diagnostic accuracy of 96.7% for the nonsurgical detection of malignancy in nonpalpable breast lesions. These results suggest that the established safety, reliability, and cost-effectiveness of FNAB can be maintained in this clinical setting. This procedure may obviate the need for open surgical biopsy in those patients with an unequivocal diagnosis of malignancy. It can also be done using standard techniques and equipment available in many community hospitals. Cancer 66:1480-1487,1990. HE ROLE OF MAMMOGRAPHY as an effective meansT of early detection of breast cancer is well established.'-4 Needle localization of occult tumors under mammographic guidance has become the principle method of sampling nonpalpable breast lesions. This technique is accurate, cost-effective, and relatively safe with reported yields of malignancy varying from 5% to 42%.5-7 On the other hand, fine-needle aspiration biopsy From the

Omega-3 and Omega-6 Fatty Acids in Blood and Breast Tissue of High-Risk Women and Association with Atypical Cytomorphology

“…A single cytopathologist, who did not have access to results from diet and tissue fatty acid measurements, scored specimens using categorical descriptions of (i) normal nonproliferative, (ii) hyperplasia, and (iii) hyperplasia with atypa. Specimens were also scored using an semiquantitative, adapted Masood cytology index (34), in which scores of 11 to 14 correspond to hyperplasia, scores of 15 to 18 hyperplasia with atypia, and 19 to 24 as suspicious for malignancy (34,35).…”

Lipid Metabolism Genes in Contralateral Unaffected Breast and Estrogen Receptor Status of Breast Cancer

“…Cytological evaluation was done on one tenth of the sample; liquid-based cytological processing (Cytyc Corporation) was used to prepare a Papanicoloau-stained slide. Cytomorphology was assessed (by CZ) and classified by Masood semiquantitative index (25), and National Institute Consensus Panel Criteria (26). The projected probability of developing cancer at 5 years was calculated for each subject according to the Gail model (7) at the time of aspiration (for cases the calculation was meant only as a summary description of breast cancer risk factors, for comparison purposes).…”

Detection of TP53 mutation, loss of heterozygosity and DNA content in fine-needle aspirates of breast carcinoma

“…Over recent years, the field of FNA application has expanded, and currently FNA spans the diagnostic assessment of palpable and non-palpable nodules and contributes to management decisions at surgical and medical levels (Masood et al, 1990;Layfield, 1992). In fact, FNA has largely replaced frozen sections and, in cases candidated to primary chemotherapy, provides hormonal receptor assessment as well as other useful pathobiological parameters with an efficiency that equals that of histology (Thomas et al, 1990;Dowell et al, 1994;Leong et al, 1996).…”