The reliability of fine-needle aspiration biopsy as the initial diagnostic procedure for palpable masses - A 4-year experience of 730 patients from a community hospital-based outpatient aspiration biopsy clinic

BACKGROUND. Fine-needle aspiration biopsy (FNAB) is a reliable, rapid, minimally invasive alternative to surgical biopsy when it is performed by physician specialists for the diagnosis of palpable masses. FNAB may be under-utilized in community hospitals in the U.S. because physicians without specialty training commonly provide the service, resulting in less reliable results. METHODS. Records were reviewed retrospectively from 730 consecutive FNAB cases that were performed and interpreted by expert cytopathologists practicing in an outpatient community hospital setting between 2000 and 2004. Data concerning patient demographics, referring physician specialty type, body sites, diagnoses, specimen adequacy, accuracy of diagnosis, and follow-up were examined and analyzed. RESULTS. FNAB was diagnostic in 93% of patients and was 95% accurate. There were 5 false-negative results and no false-positive results for the diagnosis of malignancy. The overall sensitivity of FNAB was 93%, and the specificity was 100%. Using either histology or clinical follow-up, the positive predictive value was 100%, and the negative predictive value was 99%. CONCLUSIONS. Highly reliable results can be obtained when patients are referred to specialty-trained cytopathologists practicing in the community for FNAB of palpable mass lesions. Clinicians are encouraged to seek out and support specialized FNAB services in their own communities.