Clinical Significance of Fine Needle Aspiration Biopsy and Breast Ultrasonography and Mammography in the Diagnosis of Breast Cancer

ABSTRACT

BACKGROUND: The purpose of this study was to determine the accuracy and the reliability in diagnosing breast cancer. METHODS: This clinical study was performed on 132 patients with palpable breast masses who had been diagnosed with excisional biopsy from August 1997 to July 1998 at the Department of Surgery, Seoul Adventist Hospital. Among the 132 patients, the mammographs were taken for 65 patients, ultrasonographs for 83 patients, and fine needle aspiration biopsies (FNAB) for 72 patients. The results of the three diagnostic procedures were compared with the postexcisional histologic diagnosis. RESULTS: 1) Mammography discovered breast cancer with an accuracy of 70.8%, a false positive fraction of 6.8%, a false negative fraction of 76.2%, a sensitivity of 23.8%, a specificity of 93.2%, and a positive predictive value of 62.5%. 2) Ultrasonography detected breast cancer with an accuracy of 74.7%, a false positive fraction of 6.9%, a false negative fraction of 68.0%, a sensitivity of 32.0%, a specificity of 93.1%, and a positive predictive value of 66.7%. 3) Among the 72 aspirates, 7 (9.7%) aspirates had a technically unsatisfactory aspiration cytology. 4) Of the 65 technically satisfactory cytologies, the diagnosis was malignant in 16 cases, suspicious for malignancy in 6 cases, and benign in 43 cases. 5) Aspiration cytology detected breast cancer with an accuracy of 90.8%, a false positive fraction of 4.9%, a false negative fraction of 16.7%, a sensitivity of 83.3%, a specificity of 95.1%, and a positive predictive value of 90.9%. CONCLUSIONS: The fine needle aspiration biopsy was more reliable than either mammography or ultrasonography. Also, as an initial diagnostic method, fine needle aspiration biopsy had a high degree of accuracy in diagnozing palpable breast masses.