Mammographically guided fine-needle aspiration biopsy of nonpalpable breast lesions: can it replace open biopsy?

Article Abstract:

As mammographic screening for breast cancer becomes more and more common, increasing numbers of breast lesions are being found which are too small to be felt. This, of course, raises serious questions about appropriate management. Devices and techniques have been designed which permit fine-needle biopsy of lesions which are too small to be felt by the physician trying to sample the questionable tissue. Unfortunately, there is little information to indicate how reliably such methods may actually determine the presence of cancerous cells. A study was conducted in which a fine-needle biopsy was compared directly with an open biopsy of the same lesion. Using coordinates determined from mammography, a fine needle was used to remove cells for examination. Immediately afterward, an open biopsy of the lesion was performed to provide a tissue specimen for examination. In 19 of the 71 cases, the cells aspirated from the suspicious lesion were judged to be inadequate for analysis; in four of these cases the conventional histology showed the lesion to be cancerous. Of the remaining lesions, seven malignancies were identified using the fine-needle method. However, three additional cancers were identified using conventional histology that were judged normal on the basis of the fine-needle aspiration. In no case, however, did the fine needle biopsy technique suggest the presence of cancer when the lesion was, in fact, benign. Nevertheless, the results of this comparison indicate that only 78 percent of breast cancers among impalpable lesions may be detected using the fine-needle biopsy. Therefore, the fine-needle biopsy should be regarded as insufficiently sensitive to replace the open biopsy for the investigation of suspicious breast lesions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Breast cancer

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Use of aspiration cytology and frozen section examination for management of benign and malignant thyroid nodules

Article Abstract:

Thyroid nodules are small aggregations of thyroid cells. They are relatively common, affecting 4 to 7 percent of the population of North America. The majority of thyroid nodules are benign, but these nodules pose a significant diagnostic problem: about 5 percent of the nodules are likely to be cancerous. If a diagnostic technique overlooks some of these cases, they will be undertreated or possibly not treated at all. On the other hand, if the diagnostic technique is too liberal, then many patients will undergo unnecessary surgery for what is actually a benign condition. At present, the first step in the diagnosis is made by a fine-needle aspiration (FNA) biopsy in which cells are drawn through a needle and examined under the microscope. A patient with suspicious cells is brought to surgery, but often the surgeon will not remove thyroid tissue until he gets the results of rapidly prepared frozen sections of tissue that he just removed, while the patient remains on the operating table. Only if the diagnoses from the two techniques (FNA and frozen section) agree does the surgeon proceed with the operation. To evaluate the effectiveness of this two-stage diagnostic procedure, 161 cases were reviewed. The FNA was inadequate in 9 percent of the cases and was wrong in 24 percent. The frozen sections taken while the patient was on the table were interpreted incorrectly in 22 cases (14 percent), 21 of which might have led to undertreatment. When the results of both tests were considered together, there were no false positive results, that is, there were no diagnoses of cancer in patients with benign disease. However, in five cases both the fine needle aspiration and the frozen sections failed to identify a small cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Histology, Pathological, Pathological histology, Frozen tissue sections, Frozen sections (Histology)

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Evaluation of the fine needle aspiration biopsy in the preoperative selection of cold thyroid nodules

Article Abstract:

Thyroid nodules are not uncommon, and may affect 2 to 6 percent of the population. When thyroid scans are performed to diagnosis thyroid disease, many of these nodules do not take up the radioactive tracer, and are therefore referred to as 'cold'; cold nodules may be cancerous. However, because nodules are so common and only infrequently cancerous, the surgical removal of all cold nodules is not practical. When there is concern that a cold thyroid nodule might be cancerous, a simple method of evaluation is fine needle aspiration biopsy, which can provide important diagnostic information on the basis of a rapid, safe, and inexpensive procedure. A total of 5,605 nodules from 4,609 patients were evaluated by biopsy and classified as malignant, follicular lesions, or benign growths. The results of the aspiration biopsy of 827 nodules from patients who then underwent surgery were compared with the pathological analysis of the surgical specimens. Six nodules that had not been judged cancerous at biopsy were found to be malignant; three of these were among nodules that had been classed as suspicious, and the other three had been classed as benign. The total false-negative rate was 2.3 percent. Of the nodules that had been considered malignant at biopsy, 1.1 percent proved to be benign at surgery. The authors conclude that the fine needle aspiration biopsy is an accurate method for assessing cold thyroid nodules and provides a rational basis for determining which patients require surgical intervention. (Consumer Summary produced by Reliance Medical Information, Inc.)

Examinations, Test validity

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