SOLID NONPALPABLE BREAST-LESIONS - SUCCESS AND FAILURE OF GUIDED FINE-NEEDLE ASPIRATION CYTOLOGY IN A CONSECUTIVE SERIES OF 2444 CASES

Purpose: To evaluate the contribution of guided fine-needle aspiration cytology in reducing unnecessary biopsies of benign solid nonpalpable breast lesions with low suspicion of malignancy at mammography. Mater ial anal Methods: An evaluation was made of a consecutive series of 24 44 solid nonpalpable breast lesions detected by mammography and underg oing guided (sonography or stereotaxy) fine-needle aspiration cytology . Surgical biopsy was made in the presence of strong suspicion of mali gnancy at mammography and/or of abnormal cytology. Results: The sensit ivity was 96.7% and the specificity 77.7% (average follow-up 2.77 year s). False-negative/inadequate cytology associated with low suspicion o f malignancy at mammography resulted in a diagnostic delay in 27 cance r cases (invasive 20, intraductal 7). On the other hand, cytology led to surgical biopsy in 53 cancer cases which might not otherwise have b een biopsied because of low radiological suspicion of cancer. Surgical biopsy of all cases, to avoid diagnostic delays, would have increased the benign biopsy rate by a factor of 4.5, with a rise in the benign: malignant biopsy ratio from 0.44:1 to 1.93:1.Conclusion: Stereotaxy-or ultrasound-guided fine-needle aspiration cytology of nonpalpable mamm ographic abnormalities can achieve a sharp reduction in unnecessary be nign biopsies in cases of low suspicion of malignancy at mammography.