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Role of US-guided fine-needle aspiration with on-site cytopathologic evaluation in management of nonpalpable breast lesions.
Acad Radiol. 2001 Apr; 8(4):322-7.AR

Abstract

RATIONALE AND OBJECTIVES

The purpose of this study was to evaluate the accuracy of ultrasound (US)-guided fine-needle aspiration (FNA), with radiographic follow-up or surgical excision, in conjunction with on-site cytopathologic support in the management of nonpalpable breast lesions.

MATERIALS AND METHODS

The findings of 266 consecutive mammographically or sonographically identified, nonpalpable lesions (228 patients) that underwent US-guided FNA were examined retrospectively. Clustered microcalcifications did not undergo biopsy with this method. Patients who underwent follow-up excisional biopsy or mammography with a duration of at least 24 months were included in the study.

RESULTS

In all, 117 lesions met criteria for inclusion, of which 85 (73%) were diagnosed as benign at cytopathologic evaluation and underwent mammographic follow-up of at least 24 months (range, 24-67 months; mean, 36 months). Thirty-two lesions (27%) had either malignant or atypical cytopathologic findings, for which surgery was recommended. Eleven (9%) of the 32 had malignant cytopathologic findings from initial US-guided FNA, which were confirmed at surgical excision. The remaining 21 lesions (18%) were diagnosed as atypical on the basis of US-guided FNA results. Of these, 18 lesions underwent excisional biopsy: Two were diagnosed as carcinoma (not otherwise specified), and 16 were diagnosed with a variety of benign disorders. The remaining three patients with atypical lesions chose mammographic follow-up rather than surgical diagnosis, and their conditions have remained stable for more than 24 months. Of the 85 benign cases, one changed during follow-up (12 months) and underwent repeat biopsy, with malignancy noted. The sensitivity of US-guided FNA in identifying malignant lesions was 93% (13 of 14), and the specificity of a benign finding was 100% (102 of 102). The positive and negative predictive values of US-guided FNA supported by on-site cytopathologic evaluation were 100% (13 of 13) and 99% (102 of 103), respectively.

CONCLUSION

Supported by appropriately trained on-site cytopathologists and in conjunction with follow-up mammography, US-guided FNA appears to be efficacious in the management of patients with abnormal radiographic findings. It is quick, relatively inexpensive, and minimally invasive, and, in the presence of competent cytopathologists, should be the modality of choice.

Authors+Show Affiliations

Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY 10461, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11293780

Citation

Buchbinder, S S., et al. "Role of US-guided Fine-needle Aspiration With On-site Cytopathologic Evaluation in Management of Nonpalpable Breast Lesions." Academic Radiology, vol. 8, no. 4, 2001, pp. 322-7.
Buchbinder SS, Gurell DS, Tarlow MM, et al. Role of US-guided fine-needle aspiration with on-site cytopathologic evaluation in management of nonpalpable breast lesions. Acad Radiol. 2001;8(4):322-7.
Buchbinder, S. S., Gurell, D. S., Tarlow, M. M., Salvatore, M., Suhrland, M. J., & Kader, K. (2001). Role of US-guided fine-needle aspiration with on-site cytopathologic evaluation in management of nonpalpable breast lesions. Academic Radiology, 8(4), 322-7.
Buchbinder SS, et al. Role of US-guided Fine-needle Aspiration With On-site Cytopathologic Evaluation in Management of Nonpalpable Breast Lesions. Acad Radiol. 2001;8(4):322-7. PubMed PMID: 11293780.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of US-guided fine-needle aspiration with on-site cytopathologic evaluation in management of nonpalpable breast lesions. AU - Buchbinder,S S, AU - Gurell,D S, AU - Tarlow,M M, AU - Salvatore,M, AU - Suhrland,M J, AU - Kader,K, PY - 2001/4/11/pubmed PY - 2001/7/28/medline PY - 2001/4/11/entrez SP - 322 EP - 7 JF - Academic radiology JO - Acad Radiol VL - 8 IS - 4 N2 - RATIONALE AND OBJECTIVES: The purpose of this study was to evaluate the accuracy of ultrasound (US)-guided fine-needle aspiration (FNA), with radiographic follow-up or surgical excision, in conjunction with on-site cytopathologic support in the management of nonpalpable breast lesions. MATERIALS AND METHODS: The findings of 266 consecutive mammographically or sonographically identified, nonpalpable lesions (228 patients) that underwent US-guided FNA were examined retrospectively. Clustered microcalcifications did not undergo biopsy with this method. Patients who underwent follow-up excisional biopsy or mammography with a duration of at least 24 months were included in the study. RESULTS: In all, 117 lesions met criteria for inclusion, of which 85 (73%) were diagnosed as benign at cytopathologic evaluation and underwent mammographic follow-up of at least 24 months (range, 24-67 months; mean, 36 months). Thirty-two lesions (27%) had either malignant or atypical cytopathologic findings, for which surgery was recommended. Eleven (9%) of the 32 had malignant cytopathologic findings from initial US-guided FNA, which were confirmed at surgical excision. The remaining 21 lesions (18%) were diagnosed as atypical on the basis of US-guided FNA results. Of these, 18 lesions underwent excisional biopsy: Two were diagnosed as carcinoma (not otherwise specified), and 16 were diagnosed with a variety of benign disorders. The remaining three patients with atypical lesions chose mammographic follow-up rather than surgical diagnosis, and their conditions have remained stable for more than 24 months. Of the 85 benign cases, one changed during follow-up (12 months) and underwent repeat biopsy, with malignancy noted. The sensitivity of US-guided FNA in identifying malignant lesions was 93% (13 of 14), and the specificity of a benign finding was 100% (102 of 102). The positive and negative predictive values of US-guided FNA supported by on-site cytopathologic evaluation were 100% (13 of 13) and 99% (102 of 103), respectively. CONCLUSION: Supported by appropriately trained on-site cytopathologists and in conjunction with follow-up mammography, US-guided FNA appears to be efficacious in the management of patients with abnormal radiographic findings. It is quick, relatively inexpensive, and minimally invasive, and, in the presence of competent cytopathologists, should be the modality of choice. SN - 1076-6332 UR - https://www.unboundmedicine.com/medline/citation/11293780/Role_of_US_guided_fine_needle_aspiration_with_on_site_cytopathologic_evaluation_in_management_of_nonpalpable_breast_lesions_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1076-6332(03)80501-9 DB - PRIME DP - Unbound Medicine ER -