Contribution of ultrasonography and fine-needle aspiration cytology to the differential diagnosis of palpable solid breast lesions.

Abstract

To define the role of ultrasonography (US) and fine-needle aspiration biopsy (FNAB) relative to mammography in differentiating between benign and malignant palpable solid breast lesions, and to assess the contribution of FNAB cytology to the delay between referral and the definitive diagnosis of breast cancer. We retrospectively reviewed the mammograms and US images of 84 palpable breast lesions, 63 of them also blindly. The lesions were classified as benign, indeterminate or malignant by both modalities. The results were compared with histologic diagnoses. The cytologic reports of 57 lesions were reviewed and compared to the final diagnoses. The delay from referral until diagnosis was calculated for each case. Eighty-one of the 84 lesions (96%) were visible as a local abnormality at US. Fifty-two of the 53 cancers were seen as a tumor (n=51) or an architectural distortion (n=1). In the blinded analysis, the sensitivity of FNAB cytology was 92%, specificity 83%, and overall accuracy 88%. There were no false-negative malignancies in the three modalities combined. The delay until the date of the final diagnosis was shorter in the group with a cytologic diagnosis positive for malignancy. Malignancy is unlikely if the US, mammographic and cytologic findings of a palpable breast lesion are all benign. Active and critical use of these three modalities could cut down the number of surgical biopsies of benign breast lesions and provide prompt surgical treatment for malignant lesions.