Mammographic Follow-up Research Articles

Compliance with recommended follow-up after fine-needle aspiration biopsy of nonpalpable breast lesions: a retrospective study.

To determine compliance with recommendations for mammographic or surgical follow-up after fine-needle aspiration biopsy of non-palpable breast lesions. The authors reviewed the medical records of 419 patients in whom surgical or mammographic follow-up had been recommended after fine-needle aspiration biopsy. Mammographic, clinical, and follow-up findings were correlated with patient outcome. Of 466 lesions, 395 lesions in 359 patients (age range, 24-89 years; average age, 55 years) were nonpalpable and composed the study. Excisional biopsy was recommended in 141 cases (35.7%) and close-interval mammographic surveillance in 165 (41.8%). Biopsy was performed in 122 (86.5%) of the 141 cases in which it was recommended. Of 165 cases in which follow-up mammography was recommended, 84 (50.9%) were resolved at the close of the study. In the remaining cases, women either did not return (n = 24), were followed up elsewhere or moved (n = 35), were lost to follow-up by their physicians (n = 17), or were lost to follow-up for other reasons (n = 5). Noncompliance with follow-up recommendations is an important issue undermining the benefits of fine-needle aspiration biopsy. Difficulty in tracking patients hinders assessment of patient compliance.

Mammographic changes after excisional breast biopsy for benign disease.

The purpose of this study was to establish the incidence and natural history of mammographic changes in patients within 5 years of an excisional breast biopsy. We reviewed the records of 428 consecutive patients who had undergone excisional biopsy for benign breast disease. We recorded year by year the mammographic changes seen after surgery. Because the site of surgery was known in each patient and because follow-up imaging continued for at least 2 years after biopsy, our analysis was able to exclude interval malignancy in the area of surgery. We then applied linear regression analysis to determine trends regarding progression, stability, or regression of changes after surgery. We evaluated 293 patients with 296 biopsies for which the initial mammographic study occurred within 5 years of surgery. Of those 293 patients, 237 (81%) underwent serial mammographic studies. Of the 293 patients studied, 146 patients (50%) showed no changes related to surgery. Of the remaining 147 patients (50%) who showed mammographic changes, the most common changes at initial mammographic follow-up were architectural distortion (98/205, 48%), skin thickening (35/205, 17%), and increased focal density (parenchymal scar) (30/205, 15%). Regression analysis showed no significant change of mammographic features in all patients during 5 years of follow-up (p > .2). Mammographic changes after excisional breast biopsy were seen in 50% of patients. When mammographic changes were seen, they remained stable during 5 years of follow-up. Recognition of such trends during routine surveillance should facilitate the identification of changes that represent developing malignancy.

Effect of Age, Breast Density, and Family History on the Sensitivity of First Screening Mammography

To determine factors that influence the sensitivity of modern first screening mammography. Cross-sectional. Nine counties in northern California. A total of 28 271 women aged 30 years and older referred for first screening mammography to the Mobile Mammography Screening Program of the University of California, San Francisco, from April 1985 to March 1992, of whom 238 were subsequently diagnosed as having breast cancer. Breast cancer risk profile, 2 standard mammographic views per breast, breast density, and follow-up of abnormal and normal mammography by contacting women's physicians and by linkage to the regional Surveillance, Epidemiology, and End Results tumor registry to determine the occurrence of any invasive cancer or ductal carcinoma in situ. For women aged 50 years and older, the sensitivity of first screening mammography was relatively high and decreased slightly with increasing length of follow-up after mammography: 98.5% for 7 months of follow-up, 93.2% for 13 months, and 85.7% for 25 months. Sensitivity was higher among women aged 50 years and older when breast density was primarily fatty rather than primarily dense (98.4% vs 83.7%; P < .01). For women younger than 50 years, the sensitivity of first screening mammography also decreased with increasing length of follow-up but was significantly lower than for older women: 87.5% for 7 months of follow-up, 83.6% for 13 months, and 71.4% for 25 months. For women younger than 50 years, breast density did not affect the sensitivity of mammography (81.8% for those with primarily fatty breasts vs 85.4% for those with primarily dense breasts) and was lower among those with a family history of breast cancer (68.8%). The sensitivity of modern mammography is highest among women aged 50 years and older who have primarily fatty breast density. Sensitivity is lowest among women younger than 50 years and particularly low when the time between screenings is about 2 years or when women have a family history of breast cancer, possibly because of rapid tumor growth.

Observer Agreement of Mammographic Interpretation

: The purpose of this study was to determine the inter- and intraobserver agreement of mammographic interpretation among three board-certified radiologists with different levels of expertise in mammography who interpret mammograms, and to use the data to improve quality assurance of mammography. Four hundred and ninety-five randomly selected mammograms from a pool of 9, 326 mammograms performed between 1987 and 1990 were reexamined by three board certified radiologists without prior knowledge of the original interpretations. Each radiologist was asked to assign the mammogram to any of the three categories of normal, indeterminate, and suspicious for malignancy, and also to provide recommendations for further workup (breast physical examination, short-term follow-up mammography, ultrasound, etc.). In addition, 120 mammograms were reinterpreted for the second time by the same radiologist in order to determine the intraobserver variability. Results were also compared with the original readings. Kappa statistics was used in the analysis of the agreement. The interobserver agreement for the overall diagnosis was 83.6% between radiologists #1 and #2, 86.5% between #1 and #3, and 81% between radiologist #2 and #3. The intraobserver agreement was 98.7%, 89.1%, and 100% for radiologists #1, #2, and #3, respectively. The overall agreement between the three radiologists for the interpretation of 495 mammograms was good to excellent. Some disagreement was seen in detecting suspicious calcifications, short-term follow-up recommendations, and further diagnostic workup. The study demonstrated that the overall reading of mammograms by each radiologist was significantly different from the original interpretation (p < 002). The p-value indicates that the agreement was significantly greater than would be expected by chance alone.?

Mammographic screening of women aged 40–49 years. Benefit, risk, and cost considerations

A recently published meta-analysis of seven randomized trials showed a statistically significant 24% reduction in mortality rate with the use of mammographic screening for women age 40-49 years. The benefit would have been even greater if screening had been performed at shorter annual intervals with the most up-to-date mammographic equipment. Additionally, these trials underestimated benefit due to inclusion of breast cancer deaths among study group women who refused to undergo screening. In contrast to these documented benefits, no woman has ever been shown to have developed breast cancer as a result of mammography, even with multiple examinations at doses many times higher than the current 0.25 cGy from a two-view-per-breast examination. The possibility of low dose risk has been theorized based on excess rates of cancer among populations that have received doses of 100 to more than 1000 cGy, such as atomic-bomb survivors. If there is a risk, it is negligible or nonexistent compared with the screening benefit. The total cost of screening is a summation of the following costs: (1) screening mammogram plus down-stream costs of supplementary mammographic views and/or ultrasound for further evaluation of some screenees; (2) mammographic follow-up; and (3) core or excisional biopsy for those women in whom a suspicious abnormality persists after workup. Based on a range of procedural costs, a 30% reduction in breast cancer deaths due to incidence screening of women age 40-49 will cost $6,930.00-$13,413.00 per year of life expectancy gained.

613 Ductal carcinoma in situ–prognostic significance of histological types

In a controlled clinical trial 114 patients with biopsy proven ductal carcinoma in situ were treated by breast conserving surgery without postoperative radiatioa Intraductal comedocarcinoma was found in 41%, cribriform and papillary types were found in 22%. The proportion of high-grade lesions and low-grade lesions being 1:0.6. Recurrences were found in 19%. High-grade DCIS was associated with a 15.3%, low-grade DCIS with a 12.2% recurrence rate. The recurrences did not show any correlation with the age of the patient nor the type and size of the lesion within the range of 2–46 mm. Optimal preconditions for mammographic follow-up seems to be of greater importance for the outcome of the patient than the size and type of the DCIS and the age of the patient.

770 Breast cancer (BC) after hodgkin's disease (HD). Analysis of 35 cases

Introduction The second cancers represents the most important problem among the survivors of HD. A possible link with chemotherapy (CT) and radiotherapy (RT) is suggested but genetic and immunologic factors may also be involved. Material In seven Cancer Centers, we found 35 women, previously treated for HD, who developed 37 BC. The median age at diagnosis of HD was 25 years, with 12 less than 20 years. HD stage was: 1 = 3, II = 21, III = 5, IV = 4, NS = 2. 33 women received supradiaphragmatic RT with doses varying from 35 to 45 Gy. 16 women received CT (mainly MOPP). The median interval between the diagnosis of HD and BC was 16 years. According to TNM, we found: 2 T0, 10 Tl, 12 T2, 4 T3, 6 T4 and 3 Tx. 32 were ductal infiltrating carcinoma, 2 medullary, 2 in situ and one fibrosarcoma. Axillary involvement was present in 51% of cases. Mastectomy was performed in 23 cases, a radiosurgical conservative treatment in 12 and exclusive radiotherapy in 2. Fourteen women underwent chemotherapy. Results 7 women had local relapse of BC and 15 had metastases (40%). Three had contralateral metachronous BC. 17 women are in complete remission for both diseases; 15 died of BC. Three women died of intercurrent disease. Conclusion The women treated for HD, especially before 20 years, seem to have an increased risk of subsequent BC. According to other reports, we confirm that these BC are frequently aggressive, with rapid evolution and high risk of bilaterality. Consequently, a regular mammographic follow-up is necessary to detect these lesions earlier, to allow a better prognosis and a possible conservative treatment. The second cancers represents the most important problem among the survivors of HD. A possible link with chemotherapy (CT) and radiotherapy (RT) is suggested but genetic and immunologic factors may also be involved. In seven Cancer Centers, we found 35 women, previously treated for HD, who developed 37 BC. The median age at diagnosis of HD was 25 years, with 12 less than 20 years. HD stage was: 1 = 3, II = 21, III = 5, IV = 4, NS = 2. 33 women received supradiaphragmatic RT with doses varying from 35 to 45 Gy. 16 women received CT (mainly MOPP). The median interval between the diagnosis of HD and BC was 16 years. According to TNM, we found: 2 T0, 10 Tl, 12 T2, 4 T3, 6 T4 and 3 Tx. 32 were ductal infiltrating carcinoma, 2 medullary, 2 in situ and one fibrosarcoma. Axillary involvement was present in 51% of cases. Mastectomy was performed in 23 cases, a radiosurgical conservative treatment in 12 and exclusive radiotherapy in 2. Fourteen women underwent chemotherapy. 7 women had local relapse of BC and 15 had metastases (40%). Three had contralateral metachronous BC. 17 women are in complete remission for both diseases; 15 died of BC. Three women died of intercurrent disease. The women treated for HD, especially before 20 years, seem to have an increased risk of subsequent BC. According to other reports, we confirm that these BC are frequently aggressive, with rapid evolution and high risk of bilaterality. Consequently, a regular mammographic follow-up is necessary to detect these lesions earlier, to allow a better prognosis and a possible conservative treatment.

MANAGEMENT OF PROBABLY BENIGN BREAST LESIONS

Several large-scale prospective clinical studies establish the validity of managing probably benign breast lesions with periodic mammographic surveillance as a safe and effective alternative to immediate tissue diagnosis. This approach to mammographic interpretation is now very widely accepted; the American College of Radiology indeed includes "probably benign - short interval follow-up suggested" as one of the five final assessment categories in the Breast Imaging Reporting and Data System (BI-RADS), which all American radiologists are encouraged to use. There is also general consensus that probably benign interpretations should involve (1) cases restricted to nonpalpable lesions; (2) use of the specific imaging criteria described in the prospective clinical studies; and (3) pre-interpretation comparison with prior mammograms, if available, to ensure that new or progressing lesions undergo prompt biopsy (it makes no sense to recommend follow-up for a lesion that has already demonstrated interval progression when the very demonstration of progression during surveillance is what prompts biopsy instead of continued follow-up). As yet unresolved issues concerning probably benign lesions include whether initial full problem-solving imaging should be performed in all cases, whether to use patient age and lesion size (for solitary masses) as additional criteria in deciding between the management alternatives of mammographic follow-up and immediate tissue diagnosis, and what should be the specific timing, frequency, and duration of the follow-up examinations that constitute the surveillance protocol.

Interval mammography after needle localization biopsy of breast abnormalities that are pathologically benign

Background: Needle localization biopsy is commonly performed for the diagnosis of mammographic abnormalities. Routine specimen radiography is generally recommended, but the value of routine short-interval postbiopsy mammography has not been analyzed. Patients and methods: We performed a retrospective review of 299 consecutive localized biopsies in 286 women from March 1989 to November 1993. Of these biopsies, 217 form the basis for this study; all yielded a benign pathologic diagnosis and had both specimen radiography and 3-month interval mammograms performed. Results: A total of 192 (88%) of postbiopsy mammograms were interpreted as negative, while 22 (10%) were suspicious. Three patients had second biopsies and all had benign diagnoses, 16 had follow-up mammograms that were interpreted as normal or stable, and 3 patients were lost to follow-up. A suspicious postbiopsy mammogram had no significant relationship to initial mammographic abnormality or pathologic diagnosis, but did correlate with specimen radiograph interpretation ( P = 0.02 by chi-square comparison). Conclusions: In a series of needle localization biopsies with intraoperative specimen radiography, postbiopsy mammography failed to reveal any missed cancers. Short-interval follow-up mammography is unnecessary to assess for residual abnormalities when specimen radiography confirms excision of the abnormality.

Quality assurance in breast cancer screening cytology: a review of the literature and a report on the U.K. national cytology scheme.

The National Breast Screening Programme in the United Kingdom has had an external quality assessment (EQA) scheme for breast screening histopathology since 1990. Recently, it was decided, by the Cytology sub-group of the National Co-ordinating Committee for Breast Screening Pathology, to institute two forms of cytology quality assurance. An EQA scheme is planned with circulation of slides to pathologists, but this involves extra time and effort from the participants at a time when general pathology workloads are high. Because of this, a computer routine has been written to analyse the data already present within the National Breast Screening Computer Systems, to enable the calculation of sensitivity and specificity of fine needle aspiration, correlating the cytology results with subsequent histology or follow-up mammography for lesions where no biopsy is performed. This routine uses standardised terminology and calculations and, therefore, inter-unit comparisons can be made. Where problems are identified within a unit, the Quality Assurance team can investigate the cause and institute appropriate measures to correct the problem. This article details the procedures involved in this audit and reviews the literature, recalculating the parameters in a standard manner for a number of publications. The results of the cytology quality assurance routine from seven screening units in one health region in the U.K. are presented and the measures taken to improve the level of service are discussed.

Lobular carcinoma in situ: observation without surgery as an appropriate therapy.

The finding of lobular carcinoma in situ (LCIS) in the breast has generally prompted treatment with unilateral or bilateral mastectomy. Most experts now feel that LCIS simply identifies a woman who is at high risk to develop future breast cancer and requires only close clinical and mammographic follow-up. This approach has been recommended at our institution for > 15 years. This study defines the natural history of a population of women with LCIS who were treated by observation alone. Women with a pathologic diagnosis of LCIS were identified by tumor registry search. Records and pathology were reviewed. Radiographic-pathologic correlation was performed on women who had undergone mammographic-localized breast biopsies. One hundred forty-nine women with LCIS were identified. Eighty four were excluded from analysis because of synchronous invasive cancer or ductal carcinoma in situ (DCIS). The remaining 65 women formed the basis of this report. Sixty-five women with LCIS were treated from 1963 through 1990. Median follow-up was 83 months. No women were lost to follow-up. Median age at diagnosis was 48 years (range 37-81), and 32% had a family history of breast cancer. Clinical findings leading to biopsy were breast mass in 43, nipple discharge in three, and mammographic abnormality in 19. Mammographic-pathologic correlation showed that the focus of LCIS in these 19 women was not associated with the mammographic abnormality. Fourteen of 65 women underwent mastectomy after diagnosis of LCIS (nine ipsilateral, five bilateral). Fifty-one of 65 women elected observation alone. In the observation group, 13 of 51 women (25%) underwent a second breast biopsy for a clinical or mammographic abnormality during the follow-up period. The median interval to biopsy was 50 months. Pathology was benign in two, LCIS in seven, DCIS in one, and invasive cancer in three. All seven women with LCIS on subsequent biopsy continued with observation and none developed breast cancer. All four cancers were detected by mammography without an associated palpable mass. Three of four cancer masses were < 1 cm in diameter. The woman with DCIS was 47 years of age and developed DCIS 106 months after LCIS diagnosis. She was treated by total mastectomy and is disease free 108 months later. The three women with invasive cancer developed this at 41, 53, and 69 months after diagnosis of LCIS. All were < 50 years of age. All three cancers were in the same breast as the previous LCIS. Two women were treated by modified radical mastectomy, and the third had wide excision/axillary dissection followed by radiation therapy. They are alive and disease-free at 16, 82, and 116 months. Four of 51 women treated with observation alone after diagnosis of LCIS developed breast cancer. All were detected by screening at an early stage. LCIS appeared to be an incidental finding on biopsy of mammographic abnormalities. The policy of observation alone for the finding of LCIS spares women mastectomy. Furthermore, cancers that develop in follow-up are likely to be detected at an early stage and be amenable to curative therapy. Observation alone is appropriate treatment for women with LCIS.

Mammography for screening high-risk patients for cancer: value of including a lateral projection.

Patients who have had a mastectomy are at increased risk for cancer in the contralateral breast. Annual mammographic follow-up of these patients usually consists of a two-view screening study. We examined the value of adding a 90 degrees mediolateral view to the standard examination. During a 2-year period, three-view film-screen mammograms of the contralateral breast were obtained in 750 consecutive patients who had had a unilateral mastectomy. A retrospective review was undertaken to determine the value of the third projection. The study group consisted of 710 women. Findings were abnormal on 82 mammograms in 69 patients. All 82 abnormalities (100%) were seen on the mediolateral oblique view, 73 (89%) were seen on the craniocaudal view, and 76 (93%) were seen on the 90 degrees mediolateral view. Three abnormalities were seen only on the mediolateral oblique view; none were seen only on the 90 degrees mediolateral view. Seventeen patients had biopsy because of mammographic evidence of an abnormality. Twelve (71%) had biopsy-proved malignant tumor. Inclusion of the 90 degrees mediolateral view in the standard screening examination does not increase cancer detectability.

Physicians' recommendations for mammography: do tailored messages make a difference?

Message tailoring, based on individual needs and circumstances, is commonly used to enhance face-to-face patient counseling. Only recently has individual tailoring become feasible for printed messages. This study sought to determine whether printed tailored recommendations addressing women's specific screening and risk status and perceptions about breast cancer and mammography are more effective than standardized printed recommendations. Computer-assisted telephone interviews were conducted with 435 women, aged 40 to 65 years, who had visited family practice groups within the previous 2 years. Subjects were randomly allocated to receive individually tailored or standardized mammography recommendation letters mailed from physicians to patients' homes. Follow-up interviews were conducted 8 months later. Tailored letter recipients were more likely to remember and to have read more of their letters than standardized version recipients. After controlling for baseline status, tailored letter receipt was associated with more favorable follow-up mammography status for women with incomes below $26,000 and for Black women. Tailored messages are a more effective medium for physicians' mammography recommendations; tailoring may be especially important for women of low socioeconomic status.

Contrast-enhanced MRI of the breast after limited surgery and radiation therapy.

Posttherapeutic changes in the breast after tumorectomy (TE) and radiation therapy (RT) may mimic or obscure recurrent or new malignancies and thus interfere with conventional diagnostic studies. We investigated the enhancement of tissue during variable time intervals after therapy with contrast-enhanced MRI in 62 patients. We report the results of 77 studies in 62 patients undergoing TE and RT. We include only those studies with at least 24 months of clinical and mammographic follow-up (n = 60) or histopathologic results (n = 17). Up to 9 months after therapy, differentiation between posttherapeutic changes and recurrence was frequently impossible because of the strong enhancement. Ten to 18 months after therapy, this posttherapeutic enhancement subsided slowly with some interindividual variations. After 18 months posttherapy, no significant enhancement was encountered in 30 of 32 cases. Diffuse or focal enhancement was present in all recurrent tumors and all recurrences were correctly diagnosed. Furthermore, 4 of 11 recurrences and 10 of 18 single recurrent foci were detected by MR alone, based on focal enhancement. Accordingly, contrast-enhanced MR is not recommended during the first 9 months after therapy. Nine to 18 months after therapy, it may be helpful in those two-thirds of cases where the scar does not enhance. If enhancement takes place (one-third of cases), it may represent either scar or tumor, and in such circumstances, enhanced MR is of no value. After 18 months, enhanced MRI has proven a valuable additional tool. By correctly detecting or excluding recurrent tumor, it can significantly improve diagnostic accuracy.

Fine-needle aspiration cytology of nonpalpable breast lesions: US versus stereotaxic guidance.

The authors evaluated ultrasound (US)-guided fine-needle aspiration cytology (FNAC) in 270 patients with suspicious findings at mammography. FNAC with a 10-MHz transducer and real-time scanner was performed when a lesion seen mammographically was unequivocally depicted at US. The needle was inserted with variable obliquity to the scanning plane. Stereotaxically guided FNAC was performed when lesions were not visible at US. High suspicion at mammography and positive cytologic reports led to surgical biopsy. Of the 270 lesions, 120 (44.4%) were visible at US. Opacities were the most frequently visualized lesions. Inadequate samplings were most frequently reported for opacities with smooth margins. Differences in accuracy and inadequacy rate between the two modalities were not significant. Cancer was surgically confirmed in 86 of 110 cases. The other 160 lesions were considered benign, and mammographic follow-up in 120 has shown no change. Because FNAC with US guidance was faster and less expensive, it is recommended as the technique of choice in lesions detectable with US.

Conservative surgery and radiation for early-stage breast cancer.

In selected patients with early-stage breast cancer, conservative surgery and radiation represent an alternative equal to mastectomy in terms of local recurrence, distant metastasis, survival, and long-term complications. Patients with early-stage breast cancer who are candidates for conservative surgery and radiation include those whose primary tumor is less than 4 to 5 cm in size without evidence of gross multicentricity or diffuse microcalcifications. Patients with an extensive intraductal component may be appropriate candidates provided that margins of resection are negative. Young age is not a contraindication to the conservative treatment. A preexisting history of collagen vascular disease or prior mantle irradiation for Hodgkin's or non-Hodgkin's lymphoma represents a contraindication to conservative surgery and radiation because of the potential for severe complications. An additional contraindication is the pregnant woman in whom delivery cannot be accomplished before the initiation of radiation. Mammography is essential in the pretreatment evaluation and posttreatment follow-up of the conservatively treated patient. The goal of the pretreatment mammogram is to assess the extent of disease in the ipsilateral breast as well as to evaluate the contralateral breast. In patients who present with microcalcifications, a postbiopsy mammogram before radiation is essential to document complete removal of all malignant-appearing microcalcifications. Mammography is an essential part of the follow-up program in order to detect a recurrence in the treated breast as well as a cancer in the contralateral breast cancer. The optimal interval for follow-up mammography has not been determined, although programs employing mammography on a yearly basis after treatment have been associated with the detection of early recurrences and excellent survival after salvage mastectomy for these recurrences.

Nonpalpable breast microcalcifications: frequency, management, and results of incisional biopsy.

In a series of 500 consecutive needle localizations, there were 165 biopsies for benign microcalcifications without a mass. An incisional biopsy was performed in 49 of these cases (30%). Follow-up mammograms were available for review in 39 of the cases. The average length of follow-up was 32 months. In no case did malignancy develop at the biopsy site. When an incisional biopsy is performed, careful follow-up mammography is an alternative to a repeated needle localization and biopsy in selected cases.

Nonpalpable, probably benign lesions: role of follow-up mammography.

Of 21,855 consecutive women prospectively studied with mammography, physical examination, and high-resolution ultrasonography when appropriate, 558 received a diagnosis of nonpalpable, probably benign lesions. Follow-up mammography was recommended for these patients. Characteristically benign lesions and palpable masses were excluded from analysis. The positive predictive value for detection of a nonpalpable, probably benign breast lesion was 0.017. Nine patients ultimately proved to have carcinoma; two of them had noninvasive carcinoma, and two had axillary node metastases. The positive predictive value for detection of a nonpalpable, probably malignant lesion was 0.47. The policy of recommending mammographic surveillance for nonpalpable, probably benign lesions, a viable option for radiologists, has the capability of lowering the rate and therefore the costs of biopsy procedures with negative results.

Enlarging occult fibroadenomas.

From July 1, 1989, through June 30, 1991, 1,218 preoperative wire-localization breast biopsies were performed at one institution. In this group, 254 (21%) of the abnormalities were fibroadenomas, 26 of which had enlarged or developed in the interval between routine or short-interval follow-up mammography. This interval growth was noted in 21 premenopausal women and in five who were postmenopausal and receiving oral estrogen supplementation.

Stereotaxic fine-needle aspiration of low-suspicion, nonpalpable breast nodules: valid alternative to follow-up mammography.

Seventy "low-suspicion," nonpalpable solid breast nodules were evaluated with stereotaxic fine-needle aspiration with cytologic analysis as an alternative to follow-up mammography. Sonography was performed in all cases to determine the solid nature of the nodules. Eight cysts were incorrectly classified with sonography, corresponding to atypical cysts; in such cases, however, stereotaxic fine-needle aspiration not only enabled the diagnosis, but was therapeutic as well. Fifty-eight of 70 breast aspirates (83%) yielded adequate cellular material for cytologic interpretation. A specific cytologic diagnosis was made in 52 cases (51 benign, one malignant). Insufficient cytologic material was obtained in 12 cases (17%). These results should help establish the validity of stereotaxic fine-needle aspiration with cytologic analysis as an alternative to follow-up mammography in patients with low-suspicion, solid breast nodules, reducing radiation exposure, patient anxiety, unnecessary biopsies, and costs.