DIAGNOSTIC-VALUE OF ASPIRATION CYTOLOGY I N TRIPLE DIAGNOSIS OF PALPABLE BREAST-LESIONS

The diagnostic value of aspiration cytology and the overall diagnostic quality of the so-called triple test (aspiration cytology, mammograph y and physical examination) in the evaluation of palpable breast masse s were investigated in a retrospective study. 608 histologically evalu ated cancers and 224 benign lesions were investigated. A main purpose of the study was to find out whether the triple diagnostic test can re place surgical biopsy and thereby reduce the number of unnecessary bio psies. All lesions triple-diagnosed as malignant were histologically p roved to be malignant, i.e. there were no false positive results. The rate of false negative results was found to be within the range report ed for false negative results in fresh frozen sections. Based on these results we state that the dogmatic statement ''every palpable mass in the breast must be ex cised'' should be replaced by the recommendatio n ''every palpable mass must be assessed and clarified''. A great numb er of retrospectively unnecessary biopsies can be avoided by a systema tic use of the triple diagnosis. The diagnostic safety of this method is close to that of open biopsy. In all cases where positive or negati ve concordant triplets are found, histological confirmation by biopsy can be avoided. Patients with benign lesions can be thoroughly followe d up by repeated physical and radiological examinations. Patients with triple diagnostic malignant results can be adequately treated. Lesion s for which triple diagnosis yields neither benign nor malignant, must be biopsied: This is also necessary in all cases with suspicious find ings in mammography without a palpable mass, if the equipment for ster eotactic or ultrasound- guided biopsies is not available. It must be s tated, however, that for a high-quality standard in triple test a clos e cooperation between clinician and cytologist is an absolute must.