ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION OF NONPALPABLE BREAST-LESIONS - CYTOLOGIC AND HISTOLOGIC-FINDINGS

Between 1989 and 1992, 651 nonpalpable breast lesions in 586 patients were aspirated using the ultrasound-guided technique at M.D. Anderson Cancer Center. Cytologic diagnoses were as follows: malignant, 167; su spicious, 30; benign, 211; cysts, 168; atypical ductal hyperplasia, 4; and insufficient for diagnosis, 71. In all cystic and most benign les ions, fine-needle aspiration (FNA) confirmed the benign clinical findi ngs, and surgery was not performed. Of the 483 solid lesions, 254 were subsequently treated surgically, either because of suspicious mammogr aphic or sonographic findings or because of positive or suspicious cyt ologic findings. The cytologic diagnoses in these cases were as follow s: 132 (52%) malignant, 65 (25%) benign, 26 (10%) suspicious, 4 (2%) a typical, and 27 (11%) insufficient for diagnosis. The sensitivity of u ltrasound-guided FNA for the diagnosis of malignant lesions was 91%, s pecificity 77%, and overall accuracy 84%. There were four (2%) false-n egative results. Diagnostic failures were attributed to the small size of the lesions, histologic type, and inexperience in localization and cytologic interpretation of tubular carcinoma. One (1%) false-positiv e diagnosis was made (atypical ductal hyperplasia misdiagnosed as carc inoma). The authors' findings indicate that ultrasound-guided FNA offe rs a reliable and simple alternative to open biopsy of nonpalpable bre ast lesions. The efficacy of this technique depends primarily on accur ate localization of the biopsy needle and on skillful cytologic interp retation of certain breast lesions.