THE USE OF FINE-NEEDLE ASPIRATION IN THE EVALUATION OF PERSISTENT PALPABLE DOMINANT BREAST MASSES

OBJECTIVE: Our purpose was to determine if fine-needle aspiration can decrease the necessity for open surgical biopsy in the diagnosis of a persistent palpable dominant breast mass. STUDY DESIGN: In a university obstetrics-gynecology resident physician training program, persistent palpable dominant breast masses seen in the Breast Diagnostic Center at Women's Hospital, Los Angeles County-University of Southern California Medical Center, were evaluated by fine-needle aspiration. When a cytologic diagnosis was obtained, the patients were treated, followed, or referred for treatment. Open surgical biopsy was reserved for those lesions that were not cytologically diagnosed or for which there was no concordance of the diagnostic triad of palpation, fine-needle aspiration, and mammography. RESULTS: Resident physicians rotating through the Breast Diagnostic Center performed 568 fine-needle aspirations under staff supervision. The technique was readily learned by most of the resident physicians with equipment already available in most outpatient settings. Fine-needle aspiration was performed on the initial clinic visit, and the preliminary cytologic diagnosis was given to the patient on the same day. Forty-two cancers were cytologically diagnosed (7% of the fine-needle aspirations). Seventy-five (13%) other patients were referred for open surgical biopsy as the definitive diagnostic procedure. Twenty-four (4%) patients elected open surgical excision biopsy of fine-needle aspiration-diagnosed masses. CONCLUSION: Fine-needle aspiration of persistent palpable dominant breast masses allows expeditious and potentially cost-effective management of most cases and decreases the necessity of open surgical biopsy for definitive diagnosis.