Fine Needle Aspiration Cytology in Lieu of Open Biopsy in Management of Primary Breast Cancer

Fine needle aspiration (FNA) can be used in place of open breast biopsy in most patients with primary breast cancer. This report summarizes our experience with 398 patients who had FNA of the breast. There was a total of 136 cancers, of which 100 (74%) were diagnosed by FNA. Seventy-one patients had mastectomy without frozen section. Thirteen had an excisional biopsy before mastectomy by preference of the surgeon. These cases occurred early in this series, before the surgeons became confident in the technique. The presence of locally advanced disease was confirmed by FNA in 12 patients and metastases to the breast were confirmed in four. There were no false-positives. Fine needle aspiration was interpreted as "suspicious" but not diagnostic of malignancy in 31 patients and open biopsy was requested. Biopsies demonstrated primary breast carcinoma in 22 patients and metastatic cancer in one. There were 103 patients with FNA negative for cancer who had open biopsy; 102 were confirmed negative, and one was positive for cancer. Fine needle aspiration yielded insufficient material in 38 patients, and 12 of these were found to have carcinoma with open biopsy. Advantages of FNA: It is safe, atraumatic and rapid, and permits definitive discussion about treatment planning at the initial office visit. It obviates the need for frozen section, reducing anesthesia and operative time. Our experience shows that FNA is highly accurate in the diagnosis of breast malignancy if rigorous criteria are used. Although a negative FNA requires biopsy to exclude malignancy, a FNA that is positive for cancer eliminates the need for open biopsy and allows the surgeon to proceed to mastectomy with confidence.