ANALYSIS OF RESIDUAL CANCER AFTER DIAGNOSTIC BREAST BIOPSY - AN ARGUMENT FOR FINE-NEEDLE ASPIRATION CYTOLOGY

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.