Fine-needle aspiration biopsy of nonpalpable breast lesions: challenges and promises

Intracystic papillary carcinoma of the breast in a male patient diagnosed by core needle biopsy: a case report

We report a case of intracystic papillary carcinoma (IPC) of the breast in a 71-year-old man in whom diagnosis was made by core needle biopsy. He came to our hospital complaining of a left subareolar mass. Imaging diagnosis was a cyst with an intracystic component. Since aspiration biopsy cytology was interpreted as a borderline lesion, the decision was made to proceed with core needle biopsy. Pathological examination of the specimen revealed the intracystic component to be non-invasive papillary carcinoma. So the patient underwent simple mastectomy without axillary node biopsy. From the final pathological result, no invasion was identified.

Diagnostic accuracy for different strategies of image-guided breast intervention in cases of nonpalpable breast lesions

To find out whether ultrasound-guided fine-needle aspiration (FNA) and ultrasound and stereotactic-guided large core needle biopsy (LCNB) are reliable alternatives to needle-localised open breast biopsy (NLBB) in daily practice, we performed a retrospective study and evaluated the validity of these methods. In all, 718 women with 749 nonpalpable breast lesions from three Dutch Hospitals were included, and the validity of the various methods for diagnosis was assessed. This was carried out according to a method described by Burbank and Parker for evaluating the quality of an image-guided breast intervention. We compared our results with the outcome of the COBRA study. Overall, all diagnostic strategies (NLBB, FNA, LCNB ultrasound and stereotactic guided) show comparable agreement rates. However, the miss rates differ: 2% for NLBB, 3% for COBRA (LCNB in study setting), 5% for FNA and 8–12% for LCNB in practice. Fine-needle aspiration was nonconclusive in 29%, and shows an overestimation for DCIS in 9%. The DCIS underestimate rate in NLBB was 8%. For the assessment of lesions consisting of microcalcifications only and to exclude malignancy in all other lesions, a 14-gauge needle should be used. Ultrasound-guided intervention can be performed in a large percentage of nonpalpable lesions. Lesions consisting only of microcalcifications on mammography need special attention.

Intracystic papillary carcinoma of the breast in a male patient diagnosed by ultrasound-guided core biopsy: a case report

Male breast cancer is an uncommon disease with an incidence of approximately 1% of all breast cancers. We report a case of intracystic papillary carcinoma of the breast occurring in a 67-year-old man in whom the diagnosis was made by ultrasound-guided core biopsy. This report represents the first reported intracystic papillary carcinoma diagnosed by core biopsy and illustrates the cost-effectiveness of this technique in a male patient in providing diagnostic material and allowing for expeditious planning of definitive treatment.

False-positive reports in fine needle biopsy of breast lesions

A review of the literature reveals considerable variations in the diagnostic accuracy of fine needle biopsy (FNB) of breast lesions between series, partly due to different methods of calculation, different definitions, and insufficient numbers of cases with adequate follow-up to provide reliable statistics. The best larger series have a false-positive rate between 0.2 and 0.3%, slightly higher for non-palpable than for palpable lesions. The cytological patterns of a range of benign lesions which may cause diagnostic difficulties and may be misdiagnosed as malignant by FNB are described, and guidelines to reduce the risk of false-positive diagnoses are proposed.

Role of US-guided fine-needle aspiration with on-site cytopathologic evaluation in management of nonpalpable breast lesions

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.