Hunter S. Neal

Fine-needle aspiration of the breast: Diagnoses and pitfalls. A review of 3545 cases

Fine‐needle aspiration is now a recognized diagnostic tool. In the past eight years we have studied 3545 aspirates from the breast, including both cystic and solid masses. All were prepared according to the method of Papanicalaou. The cellular findings are described and discussed. Abnormal cells were found in the aspirates from 90% of the 368 malignancies. Reliable criteria for diagnosis are emphasized and diagnostic pitfalls discussed. Aspiration biopsy was helpful in the management of all patients with breast lesions. The method is rapid, accurate, and essentially complication‐free. It should be used with the idea of complementing, not competing with, routine histologic biopsy.

Final diagnosis by fine-needle aspiration biopsy for definitive operation in breast cancer

This work has been based on 15 years experience with more than 10,000 needle aspiration biopsies of the breast. Fine-needle aspiration biopsy was used in place of open breast biopsy for definitive operation in breast cancer. Our experience with 2,623 aspiration biopsies over a 3 year period has been reviewed. There was a total of 323 cancers, of which 257 (80 percent) were unequivocally diagnosed by fine-needle aspiration biopsy. Definitive operation was performed in 244 of these patients (95 percent) without open biopsy. Thirteen had an excisional biopsy before definitive operation at the request of the referring physician. The sensitivity was 80 percent and the specificity was 98 percent. There were no false-positive diagnoses. The positive predictive value was 100 percent. False-negative diagnoses were made in 9 percent of the patients, half of whom had nonpalpable carcinomas. Our experience shows that fine-needle aspiration biopsy is accurate in the diagnosis of breast cancer, and when the finding is positive, it can be used for definitive breast operation, eliminating the need for open biopsy. A management algorithm has also been presented herein.

Influence of surgical technique on estrogen and progesterone receptor determinations in breast cancer

The effect of surgical technique on hormone receptor values in breast cancer tissue was examined. One hundred and thirty‐one women with breast cancer were divided into three groups: Group I, definitive diagnosis at frozen section and tissue taken for receptor determination; Groups II and III, diagnosis made by aspiration biopsy cytology, with tissue obtained from modified radical mastectomy in Group II and tissue obtained from mastectomy performed separately, prior to axillary lymph node dissection, in Group III. The rates of estrogen and progesterone receptor positivity, and the mean levels of receptor, did not differ significantly among the three groups. Thus tumor tissue from a mastectomy specimen can be reliably used for hormone receptor determinations, if the tumor tissue is kept cold and rapidly frozen for storage. Women whose cancer has been diagnosed by aspiration biopsy cytology need not undergo an additional open biopsy solely to obtain tissue for receptor determinations.

Role of needle aspiration biopsy in diagnosis of carcinoma of the breast.

Needle aspiration of a breast mass, a procedure widely employed in Scandinavia but neglected in the United States, has an imporant role in the diagnosis of carcinoma of the breat. Five hundred and ninety-seven patients has aspirations from 706 lesions, 415 solid and 291 cystic. There were 83 malignancies, with abnormal cells in 73. In the majority the diagnosis could be made readily. There is no known contraindication to the procedure. Aspiration at the initial visit may alert the physician to malignancy, thus avoiding undue delay in treatment.

Aspiration biopsy cytology of occult breast lesions by use of the “scouting needle”. A prospective study of 261 cases

The increased use of mammography for the detection of impalpable breast lesions has resulted in a need for new diagnostic techniques. In a prospective study of 261 occult breast lesions, aspiration biopsy was done with a standard fine needle and syringe. This “scouting needle” technique permits the collection of diagnostic cytologic material in the clinicians office without specialized radiologic equipment. Thirty of 53 malignant lesions (57%) were detected cytologically. A benign cytologic diagnosis, which was made in 220 patients, did not preclude additional investigation. Aspiration biopsy using the “scouting needle” is a rapid, low‐cost, easily performed, initial procedure which complements “watchful waiting.” When diagnostic of carcinoma, it results in immediate surgical intervention and may obviate two‐stage surgical treatment.