The Diagnostic Accuracies of Fine Needle Aspiration Biopsy, Mammography and Ultrasonography in Palpable Breast Mass

ABSTRACT

BACKGROUND: Although an increasing number of breast abnormalities are detected by screening mammography, most breast cancers are presented as a palpable mass. Cytologic specimens are frequently diagnostic and may be easier to obtain. This study was done to compare the diagnostic accuracies of clinical breast exam, fine needle aspiration biopsy (FNAB), mammography and ultrasonography, and to establish the algorithm to manage the patients based on the results of FNAB. METHODS: From Jan. 1992 to Dec. 1997, one hundred and twenty-seven women out of 470 patients with a clinically palpable mass underwent concurrent FNAB, mammography, and ultrasonography. All patients ultimately had histologic confirmation by surgical biopsy. RESULTS: The sensitivity and the specificity of the tests were as follows 79.2% and 74.4%, respectively, for clinical breast exam; 62.2% and 98.6%, for mammography; 55.8% and 93.3% for ultrasonography; and 66.7% and 100% for FNAB. Of note, the accuracy of the FNAB was significantly higher for lesions 2 cm or larger than for lesions smaller than 2 cm (p=0.034). All patients who were positive for malignancy on FNAB (n=20) presented with breast cancer. Among the 16 patients with suspicious results on FNAB and breast cancer on surgical biopsy, 3 had normal findings on mammography and ultrasonography. In the cases of negative findings for malignancy in three tests (n=55), no breast cancer was found on the final surgical specimen. CONCLUSION: It is recommended that FNAB must be performed on all palpable masses and that when the FNAB is postive for cancer, definitive surgery be performed with intraoperative frozen biopsy. Patients in whom mammography, ultrasonography and FNAB were negative for malignancy can be observed without the need for an open biopsy. Additionally, (1) when the results of FNAB are suspicious or (2) when the mammagraphy and ultrasonography results are suspicious even though the FNAB results are negative for malignancy, an open biopsy is required to exclude the possibility of the breast cancer.