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. 1975 Jul;182(1):1–8. doi: 10.1097/00000658-197507000-00001

The diagnostic accuracy of palpation and fine-needle biopsy and an evaluation of their combined use in the diagnosis of breast lesions: report on a prospective study in 1244 women with symptoms.

A Rimsten, B Stenkvist, H Johanson, A Lindgren
PMCID: PMC1343869  PMID: 1170819

Abstract

In 1244 women with breast symptoms an evaluation by means of palpation was made with respect to diagnosis of malignancy according to a four-grade scale ranging from "definite cancer" to "no cancer." Aspiration biopsy and cytologic examination were then performed in 984 breast lesions. The diagnosis from the cytologic evaluation ranged from benign, through three grades of atypia (slight, moderate, grave) to cancer. A histologic diagnosis was made in 411 cases and in 28% it was cancer. Cancer was found in 92.5% of the patients with a palpatory diagnosis of "definite cancer," and in 50% of those with a palpatory diagnosis of "strong suspicion of cancer." In all patients in whom cancer was diagnosed cytologically, the same diagnosis was made at histology, while 87.5% of those with grave atypia at the cytologic examination were diagnosed histologically as having cancer. A false negative cytologic diagnosis was made in 4% of the cancer cases. With a combination of palpation and cytology, 91% of the cancer cases fell within the groups "definite cancer," "strong suspicion of cancer" (palpation)/"cancer," "grave atypia" (cytology). No patients with cancer were evaluated as "no cancer" (palpation)/"no atypia" (cytology). In this group of 697 patients, however, one cancer was discovered after 7 months. The investigation showed that a thorough palpatory evaluation is a prerequisite for a good result of aspiration biopsy, in particular to meet the risk of a false negative cytologic diagnosis. The cytologic examination revealed cancer in 6 and 12 cases, respectively, when palpation gave no or some suspicion of cancer, and in many cases it was able to eliminate malignancy suspected on palpation. Cytologic atypia indicated cancer in a relatively high per cent, but was also noted in many cases found to be benign histologically. The possibilities of reducing the number of "unnecessary" surgical biopsies by using a combination of palpation and cytology is discussed.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Evers R., Fischedick O. Die Punktionsbiopsie des Mammakarzinoms. Fortschr Geb Rontgenstr Nuklearmed. 1973;118(4):466–472. [PubMed] [Google Scholar]
  2. Franzén S., Zajicek J. Aspiration biopsy in diagnosis of palpable lesions of the breast. Critical review of 3479 consecutive biopsies. Acta Radiol Ther Phys Biol. 1968 Aug;7(4):241–262. doi: 10.3109/02841866809133198. [DOI] [PubMed] [Google Scholar]
  3. Hennig K., Johansson H., Rimsten A., Stenkvist B. X-ray and fine-needle biopsy in diagnosis of non-palpable breast lesions. Acta Cytol. 1975 Jan-Feb;19(1):7–10. [PubMed] [Google Scholar]
  4. Hollender A., Persson R. Ett nytt handtag för engångssprutor. FinSPETS TILL VARDAGS. Lakartidningen. 1971 Jan 20;68(4):292–293. [PubMed] [Google Scholar]
  5. Ionesco V. T. Le cytodiagnostic du cancer du sein. Minerva Ginecol. 1971 May 15;23(9):413–416. [PubMed] [Google Scholar]
  6. Kreuzer G., Boquoi E., Meyer R. D. Die Diagnostik gut- und bösartiger Mammatumoren. Ergebnisse einer kombinierten klinischen, mammographischen und zytologischen Untersuchung (Tripel-Diagnostik. Dtsch Med Wochenschr. 1973 Apr 6;98(14):691–698. doi: 10.1055/s-0028-1106888. [DOI] [PubMed] [Google Scholar]
  7. MASSIE F. M., MCCLELLAN J. T. An analysis of 1500 breast biopsies. Am Surg. 1960 Aug;26:509–515. [PubMed] [Google Scholar]
  8. OCHSNER A., Jr, GRIFFITH W. E. CRITICAL EVALUATION OF MAMMOGRAPHY IN THE MANAGEMENT OF BREAST DISEASE. Ann Surg. 1965 May;161:748–752. doi: 10.1097/00000658-196505000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Patchefsky A. S., Potok J., Hoch W. S., Libshitz H. I. Increased detection of occult breast carcinoma after more thorough histologic examination of breast biopsies. Am J Clin Pathol. 1973 Dec;60(6):799–804. doi: 10.1093/ajcp/60.6.799. [DOI] [PubMed] [Google Scholar]
  10. Rajcic V. Cytologic studies of aspiration biopsy of the breast. Critical review of 2,890 consecutive biopsies. Minerva Ginecol. 1971 May 15;23(9):417–419. [PubMed] [Google Scholar]
  11. SHALLOW T. A., WAGNER F. B., Jr, COLCHER R. E. Adequate breast biopsy; experience in one thousand consecutive personal cases. AMA Arch Surg. 1953 Oct;67(4):526–536. [PubMed] [Google Scholar]
  12. SMITH I. H., FISHER J. H., LOTT J. S., THOMSON D. H. The cytological diagnosis of solid tumours by small needle aspiration and its influence on cancer clinic practice. Can Med Assoc J. 1959 Jun 1;80(11):855–861. [PMC free article] [PubMed] [Google Scholar]
  13. STORRS H. G. The role of excision biopsy in lesions of the breast. Am Surg. 1952 Dec;18(12):1199–1206. [PubMed] [Google Scholar]
  14. Shepard D., Soder P., Cooper D., Eaton B., Godwin J. T. Mammography: an aid in the treatment of carcinoma of the breast. Ann Surg. 1974 May;179(5):749–756. doi: 10.1097/00000658-197405000-00030. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Snyder R. E., Rosen P. Radiography of breast specimens. Cancer. 1971 Dec;28(6):1608–1611. doi: 10.1002/1097-0142(197112)28:6<1608::aid-cncr2820280640>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  16. URBAN J. A. Treatment of early cancer of the breast. Postgrad Med. 1960 Mar;27:389–393. doi: 10.1080/00325481.1960.11712851. [DOI] [PubMed] [Google Scholar]
  17. Venet L., Strax P., Venet W., Shapiro S. Adequacies and inadequacies of breast examinations by physicians. Cancer. 1969 Dec;24(6):1187–1191. doi: 10.1002/1097-0142(196912)24:6<1187::aid-cncr2820240619>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  18. Verhaeghe M., Cornillot M., Herbeau J., Wurtz A., Verhaeghe G. Le triple diagnostic cyto-radio-clinique dans les tumeurs du sein (à propos de 2 460 cas) Mem Acad Chir (Paris) 1969;95(1):48–62. [PubMed] [Google Scholar]
  19. Zajicek J., Caspersson T., Jakobsson P., Kudynowski J., Linsk J., Us-Kraŝovec M. Cytologic diagnosis of mammary tumors from aspiration biopsy smears. Comparison of cytologic and histologic findings in 2,III lesions and diagnostic use of cytophotometry. Acta Cytol. 1970 Jul-Aug;14(7):370–376. [PubMed] [Google Scholar]

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