BREAST FINE-NEEDLE ASPIRATION CYTOLOGY - UTILITY AS A SCREENING TOOL FOR CLINICALLY PALPABLE LESIONS

We examined breast fine needle aspiration cytology's role as a screeni ng tool in addition to mammography and clinical examination for palpab le breast lesions, circumventing operative biopsy of benign lesions wh ile identifying cancer for definitive treatment and significant ductal proliferations that need histologic evaluation, such as atypical duct al hyperplasia and marked ductal hyperplasia. Five hundred thirty-thre e consecutive palpable breast lesions in 498 patients referred to cyto pathologists were aspirated and the cytologic findings reported as fol lows: (1) malignant, treat as any histologic diagnosis of breast cance r (85); (2) suspicious, intraoperative or biopsy confirmation before t herapy (11); (3) atypical, biopsy recommended to exclude breast cancer or significant ductal proliferation (atypical ductal hyperplasia and marked ductal hyperplasia) (45); (4) benign, excision not necessary (3 34); and (5) nondiagnostic, no ductal cells, and biopsy recommended if indicated clinically (58). Excision of 57185 malignant lesions confir med cancer in all cases. Follow-up of the remaining 28 patients showed : 17 were undergoing treatment for cancer without surgery, 8 were dead of the disease, and 3 were lost to follow-up. Biopsy of 11/11 suspici ous lesions confirmed cancer. Biopsy of 27145 atypical lesions showed: 1 carcinoma, 12 significant ductal proliferations (1 atypical ductal hyperplasia and 11 marked ductal hyperplasia) and 14 benign, nonprolif erative breasts; 18 atypical lesions from 14 patients were not biopsie d. Biopsy of 611334 benign lesions showed 51 benign nonproliferative b reasts, 7 missed significant ductal proliferations (6 marked ductal hy perplasia and 1 atypical ductal hyperplasia) and 3 false negatives (3 carcinomas). The three false negatives and the atypical ductal hyperpl asia had a biopsy because of an abnormal mammogram. Review of material from false-negative cases showed underinterpretation of cells present on cytology slides in two cases and carcinoma missed by the aspiratio n needle in one case. The atypical ductal hyperplasia was in a separat e, nonpalpable area in the same breast. Biopsy was avoided in 2731334 benign lesions from 249 patients: 86 had no follow-up, 160 had stable lesions, and 3 reported a change in their lesions (mean follow-up, 13 months). One of these three had a biopsy that showed a benign, nonprol iferative breast. Biopsy of 11/58 nondiagnostic lesions showed 9 benig n nonproliferative breasts, 1 atypical ductal hyperplasia and 1 carcin oma. No biopsy was performed on 47158 nondiagnostic lesions from 45 pa tients: 1 had a repeat aspiration that was malignant, 10 had no follow -up, 33 had stable lesions, and 1 had an increase in the size of her l esion (mean follow-up, 13 months). Aspiration cytology is an effective screening tool for palpable breast lesions when coupled with mammogra phy and clinical examination. After aspiration cytology, 58% of surgic al material had carcinoma, atypical ductal hyperplasia or marked ducta l hyperplasia. However, patients with palpable breast lesions and beni gn or nondiagnostic aspiration cytology diagnoses need mammography and close clinical follow-up to identify false-negative diagnoses.