European Society of Mastology Study Group on detection and diagnosis. Proceedings of the EUSOMA seminar on nonpalpable breast lesions Florence, 18 June 1993. Recommendations for the management of nonpalpable lesion detected by mammography

Mammographically-guided fine needle aspiration in differential diagnosis of cystic versus solid rounded masses smaller than 2 cm detected at mammographic screening

PURPOSE

To evaluate mammographically-guided fine needle aspiration (FNA) in the differential diagnosis of smaller cystic and solid rounded masses, detected at screening.

MATERIALS AND METHODS

All mammographically-guided FNAs performed in a consecutive series of 5013 women recalled in a population-based screening programme were reviewed. FNA was done with a perforated compression plate in 369 masses and stereotactically in 259 masses. More than 3 years of mammographic follow-up were available for 267 cysts. Results from ultrasound examinations were available for a subset of 69 cysts.

RESULTS

A total of 344 rounded masses were diagnosed as benign cysts and 284 as solid masses. Surgical biopsy was performed in 75 masses. Two surgically biopsied masses proved to be cysts, one where the aspirate was misinterpreted as suspicious for mucinous cancer, and one where FNA failed to prove a cyst. In another case initially regarded as cyst, a rounded ductal cancer in situ was diagnosed 2 years later in the same location. Thus, among 267 masses diagnosed as benign cysts and followed up for 3 years, only one proved to be malignant. Ultrasound failed to visualise 35% (24/69) of smaller cysts.

CONCLUSION

Mammographically-guided FNA is a valuable method to differentiate smaller cysts from solid rounded masses and hence to avoid unnecessary surgical biopsies.

Diagnosis of non-palpable breast cancer: a review

The literature on several methods of diagnosing non-palpable breast carcinoma has been reviewed. Skin projection and dye are methods not frequently used. Several aspects of FNA biopsy/cytology, ultrasound-directed methods, frozen section and MRI localization procedures are highlighted and comparisons are made. Much attention is being payed to needle localization breast biopsy and stereotactic core needle breast biopsy. The management of patients with mammographic abnormalities is shifting from needle localization to breast biopsy stereotactic core needle biopsy. Items of comparison between the two mentioned methods are accuracy, indications, complications and costs. The role of the ABBI system in the management of breast cancer has not yet been defined. A cooperative effort between the mammographer, surgeon and pathologist is critical to a successful image-guided breast biopsy programme.