Stereotactic fine-needle aspiration for cytologic diagnosis of nonpalpable breast lesions.

Abstract

Fine-needle aspiration for cytologic diagnosis was performed on 219 nonpalpable breast lesions by using a stereotactic localization technique. Cytologic results were correlated with mammographic findings, and therapeutic decisions were based on the results of both procedures. Representative cytologic material was obtained in 74% of the lesions. Strict criteria of representativeness were observed. If only cases with representative cytologic yield are considered, the sensitivity was 93% and the specificity was 97%. The predictive values were high except for the predictive value of a negative cytologic finding in a spiculated lesion (50%). Sampling errors caused by abundant fibrosis, needle deviation, and difficulty in defining the lesion on the stereoscopic views are discussed. Another source of sampling error may be the mixed nature of some lesions consisting of benign and malignant components. Fine-needle aspiration of 219 nonpalpable breast lesions by using a stereotactic localization device yielded representative cytologic samples in 74% of the lesions.

Rate of insufficient samples for fine-needle aspiration for nonpalpable breast lesions in a multicenter clinical trial

“…proof from open surgical biopsy, nor has there been long term clinical follow-up on all cases. 19,25,30,31 Our results show that the insufficient sampling rate for FNA is high for both masses and calcified lesions, Consequently, the results of FNA, although generally promising, have been variable. In studies in which and that a small number of patients whose FNA specimens were interpreted as benign or atypical by FNA FNA cytology for nonpalpable breast lesions has been compared with open biopsy outcomes, the results had CNB or surgical specimens interpreted as malignant.…”

“…[12][13][14][15][16][17] The most likely complications (fainting, infection, and hematoma) are stereotactic localization techniques for needle placement reportedly increases the number of insufficient rare, even with the use of large needles. [18][19][20] The dose of radiation with stereotactic guidance (estimated to FNA samples. [39][40][41][42][43] The best results have been reported from a single center with a single person performing be 645 mR) is not significant to the breast as a whole and is considered acceptable for the specifically tarthe aspirations.…”

“…However, during an interim analysis three passes of the needle and a coaxial approach to two to four punctures without the coaxial techof the data, the Data Safety and Monitoring Board for the study recommended closing the arm of the trial nique. 15,17,19,23,25,27 No definitive studies specifically have addressed the optimal number of passes needed that involved FNA. It did this because its members believed that the overall insufficient sampling rate for for FNA of nonpalpable lesions.…”

“…In this article, we present information on the inthe operators, the types of lesions sampled, the considerably different types of stereotactic device used, the sufficient sampling rate of FNA overall, by type of mammographic lesion (calcification or mass), and by experience of the interpreting cytopathologists, and the methods of specimen preparation. 13,17,19,20,[23][24][25][29][30][31] degree of mammographic suspicion regarding the possibility of malignancy. We also show the final diagPrevious research protocols also have varied and not all studies have compared FNA results with histologic noses as determined from specimens obtained by FNA compared with those obtained from CNB or surgery.…”

Stereotactic fine-needle aspiration cytology of nonpalpable breast lesions

“…In the study by Azavedo et al, 26 Ciatto et al, 15 Löfgren et al, 31 Layfield et al, 34 Fajardo et al, 30 Hann et al, 29 Pressler et al, 37 and Svane et al 23 atypical, proliferative, or suspicious cytologies were classified as suspicious. In the study by Masood et al 32 proliferative disease with or without atypia were classified histologically as benign whereas proliferative disease with atypia was classified cytologically as suspicious.…”