Ce. Cox et al., ANALYSIS OF RESIDUAL CANCER AFTER DIAGNOSTIC BREAST BIOPSY - AN ARGUMENT FOR FINE-NEEDLE ASPIRATION CYTOLOGY, Annals of surgical oncology, 2(3), 1995, pp. 201-206
Background: Diagnostic breast biopsy (DxBx) requires an effective stra
tegy for successful treatment of breast cancer by lumpectomy or mastec
tomy, Clearance of margins is required to achieve local control. Metho
ds: We reviewed 844 malignant diagnostic biopsies, The strategy was to
perform DxBx on all nonpalpable lesions and fine-needle aspiration (F
NA) on all palpable lesions. When FNA was equivocal, DxBx was performe
d. After positive DxBx, either the biopsy cavity or FNA-positive breas
t mass was excised, and margins were documented with touch preparation
cytology analysis (TPC) and frozen section (FS) as necessary to achie
ve negative margins. Results: Outside institutions referred 430 excisi
onal biopsies, Two hundred twenty-five (52.3%) were found to have resi
dual cancer at surgical excision. Our institution performed 414 biopsi
es: 169 were performed on nonpalpable lesions in which 58% had residua
l tumor at resection; 245 were diagnosed by FNA of palpable lesions. R
esidual disease was found in 12 (5%). Conclusions: Of patients who und
ergo DxBx, >50% have residual breast cancer. It is recommended that (a
) FNA be performed on all palpable masses or DxBx of nonpalpable masse
s; when cancer is diagnosed, proceed to surgical excision. (b) When lu
mpectomy is the option, margins should be reexcised and intraoperative
ly evaluated with TPC and FS at the time of axillary dissection.