FINE-NEEDLE ASPIRATION BIOPSY OF PROLIFERATIVE BREAST DISEASE

Proliferative breast disease (PBD) is a well-recognized histologic ent ity that has received increasing attention in the cytologic literature . We have attempted to prospectively identify and subclassify PBD by f ine needle aspiration biopsy since 1987 using criteria we developed th rough our experience. Over 2800 breast FNABs were performed on breast lesions from 1987 to mid-1992; 257 were cytologically diagnosed as PBD with or without atypia. Eighty-four were significantly worrisome clin ically to warrant surgical excision. Forty of these were designated PB D without atypia by cytology; 23 (58%) were in agreement with histolog y; three (8%) were PBD with atypia by histology; five (13%) were cance rs; and nine (22%) were nonproliferative. Forty-four cases were design ated PBD with atypia; 24 (55%) were in agreement with the histologic d iagnosis; 12 (27%) proved to be PBD without atypia; six (13%) were car cinoma; and two (5%) were nonproliferative. After 1991 we employed str icter criteria for PBD, improving on the results from 1991-1992. Durin g this period, there were 53 diagnoses of PBD with or without atypia a nd 34 were excised. Nine of the 10 (90%) aspirates designated as PBD w ithout atypia were in agreement with histologic findings. The other ca se was nonproliferative. Fifteen of the 24 cases diagnosed as PBD with atypia were in concordance with histologic findings (63%), one was no nproliferative, seven were PBD without atypia (29%), and one (4%) prov ed to be carcinoma. Using likelihood ratios, were are able to show tha t the FNAB diagnosis of PBD with or without atypia can be used in asso ciation with the clinical impression of high-risk lesions to determine the post-FNAB likelihood of disease regardless of which criteria were used.