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Fine-Needle Aspiration of Palpable Breast Masses: A Program for Staged Implementation

Fine-Needle Aspiration of Palpable Breast Masses: A Program for Staged Implementation Abstract • Fine-needle aspiration (FNA) can provide a morphologic diagnosis of palpable breast masses in an accurate, efficient, inexpensive, and safe manner. However, how one acquires the skill to perform the FNA and interpret the resulting smears, while protecting the patient from the risk of false-positive or false-negative results, is scarcely considered. We used a three-phase program to acquire experience with FNA while providing services for 205 patients over a 16-month period. We performed FNA sequentially in vitro, in vivo, and finally in vivo for clinical use. With available literature and this graduated implementation program, physicians totally inexperienced with FNA can achieve results similar to those of medical centers having experience with thousands of patients. (Arch Surg 1983;118:859-863) References 1. Franzen S, Zajicek J: Aspiration biopsy in diagnosis of palpable lesions of the breast: Critical review of 3,479 consecutive biopsies . Acta Radiol 1968;7:241-261.Crossref 2. Zajdela A, Ghossein NA, Pilleron JP, et al: The value of aspiration cytology in the diagnosis of breast cancer: Experience at the Fondation Curie . Cancer 1975;35:449-506.Crossref 3. Hajdu SI, Melamed MR: The diagnostic value of aspiration smears . Am J Clin Pathol 1973;59:350-356. 4. Strawbridge HTG, Bassett AA, Foldes I: Role of cytology in management of lesions of the breast . Surg Gynecol Obstet 1981;152:1-7. 5. Kline TS, Joshi LP, Neal HS: Fine-needle aspiration of the breast: Diagnoses and pitfalls: A review of 3,545 cases . Cancer 1979;44:1458-1464.Crossref 6. Kern WH: The diagnosis of breast cancer by fine-needle aspiration smears . JAMA 1979;241:1125-1127.Crossref 7. Koivuniemi AP: Fine-needle aspiration biopsy of the breast . Ann Clin Res 1976;8:272-283. 8. Zajicek J: Aspiration Biopsy Cytology . Basel, Switzerland, S Karger AG, 1974. 9. Schondorf H: Aspiration Cytology of the Breast . Philadelphia, WB Saunders Co, 1978. 10. Robbins GF, Brothers JH, Eberhart WF, et al: Is aspiration biopsy of breast cancer dangerous to the patient? Cancer 1954;7:774-778.Crossref 11. Berg JW, Robbins GF: A late look at the safety of aspiration biopsy . Cancer 1962;15:826-827.Crossref 12. Coel MN, Niwayama G: Safety of percutaneous fine-needle pancreatic biopsy: A porcine model . Invest Radiol 1978;13:547-549.Crossref 13. Duguid HID, Wood RAB, Irving AD, et al: Needle aspiration of the breast with immediate reporting of material . Br Med J 1979;2:185-187.Crossref 14. Fentimen IS, Millis RR, Hayward JL: Value of needle biopsy in outpatient diagnosis of breast cancer . Arch Surg 1980;115:652-653.Crossref 15. Fox CH: Innovation in medical diagnosis: The Scandinavian curiosity . Lancet 1979;1:1387-1388.Crossref 16. Koss LG: Thin needle aspiration biopsy of endocrine organs . Ann Clin Lab Sci 1979;9:326-332. 17. Koss LG: Thin needle aspiration biopsy . Acta Cytol 1980;24:1-3. 18. Frable WJ: Thin-needle aspiration biopsy: A personal experience with 469 cases . Am J Clin Pathol 1976;65:168-182. 19. Schour L, Chu EW: Fine needle aspiration in the management of patients with neoplastic disease . Acta Cytol 1974;18:472-476. 20. Coleman D, Desai S, Dudley H, et al: Needle aspiration of palpable breast lesions: A new application of the membrane filter technique and its results . Clin Oncol 1975;1:27-32. 21. Wilson SL, Ehrmann RL: The cytologic diagnosis of breast aspirations . Acta Cytol 1978;22:470-475. 22. Linsk J, Kreuzer G, Zajicek J: Cytologic diagnosis of mammary tumors from aspiration biopsy smears: II. Studies on 210 fibroadenomas and 210 cases of benign dysplasia . Acta Cytol 1972;16:130-138. 23. Kern WH, Dermer GB: Cytopathology of hyperplastic and neoplastic mammary duct epithelium . Acta Cytol 1972;16:120-129. 24. Kreuzer G: Aspiration biopsy cytology in proliferating benign mammary dysplasia . Acta Cytol 1977;22:128-132. 25. Wallgren A, Zajicek J: Cytologic presentation of mammary carcinoma on aspiration biopsy smears . Acta Cytol 1976;20:469-478. 26. Galen R, Gambino SR: Beyond Normality: The Predictive Value and Efficiency of Medical Diagnosis . New York, John Wiley & Sons Inc, 1975. 27. Sparkman RS: Reliability of frozen sections in the diagnosis of breast lesions . Ann Surg 1962;155:924-934.Crossref 28. Information 1981 . Tampa, Fla, American Board of Pathology, 1981. 29. Feldman JG, Carter AC, Nicastri AD, et al: Breast self-examination: Relationship to stage of breast cancer at diagnosis . Cancer 1981;47: 2740-2745.Crossref 30. Huguley CM, Brown RL: The value of breast self-examination . Cancer 1981;47:989-995.Crossref 31. McLoughlin MJ, Ho CS, Langer B, et al: Fine needle aspiration biopsy of malignant lesions in and around the pancreas . Cancer 1978;41: 2413-2419.Crossref 32. Sinner WN, Zajicek J: Implantation metastasis after percutaneous transthoracic needle aspiration biopsy . Acta Radiol 1976;17:473-479. 33. Ferrucci JT, Wittenberg J, Margolies MN, et al: Malignant seeding of the tract after thin-needle aspiration biopsy . Radiology 1979;130:345-346.Crossref 34. Engzell U, Jakobsson PÅ, Sigurdson Å, et al: Aspiration biopsy of metastatic carcinoma in lymph nodes of the neck: A review of 1,101 cases . Acta Otolaryngol 1971;72:138-147.Crossref 35. Engzell U, Esposti PL, Rubio C, et al: Investigation on tumour spread in connection with aspiration biopsy . Acta Radiol 1971;10:385-398.Crossref 36. Von Schreeb T, Arner O, Skovsted G, et al: Renal adenocarcinoma: Is there a risk of spreading tumour cells in diagnostic puncture? Scand J Urol Nephrol 1967;1:270-276.Crossref 37. Zajicek J: Fine-needle aspiration biopsy of palpable breast lesions , in Logan WW (ed): Breast Carcinoma . New York, John Wiley & Sons Inc, 1977, pp 319-324. 38. Kreuzer G, Zajicek J: Cytologic diagnosis of mammary tumors from aspiration biopsy smears: III. Studies on 200 carcinomas with false negative or doubtful cytologic reports . Acta Cytol 1972;16:249-252. 39. Holaday WJ, Assor D: Ten thousand consecutive frozen sections: A retrospective study focusing on accuracy and quality control . Am J Clin Pathol 1974;61:769-777. 40. Rosen PP: Frozen section diagnosis of breast lesions: Recent experience with 556 consecutive biopsies . Ann Surg 1978;187:17-19.Crossref 41. Patchefsky AS, Potok J, Hoch WS, et al: Increased detection of occult breast carcinoma after more thorough histologic examination of breast biopsies . Am J Clin Pathol 1973;60:799-804. 42. Rimsten A, Stenkvist B, Johanson H: The diagnostic accuracy of palpation and fine-needle biopsy and an evaluation of their combined use in the diagnosis of breast lesions . Ann Surg 1975;182:1-8.Crossref 43. Kreuzer G, Boquoi E: Aspiration biopsy cytology, mammography and clinical exploration: A modern set up in diagnosis of tumors of the breast . Acta Cytol 1976;20:319-323. 44. Kline TS: Masquerades of malignancy: A review of 4,241 aspirates from the breast . Acta Cytol 1981;25:263-266. 45. Nakazawa H, Rosen P, Lane N, et al: Frozen section experience in 3,000 cases: Accuracy, limitations, and value in residency training . Am J Clin Pathol 1968;49:41-51. 46. Lazaro EJ, Rush BF, Swaminathan AP: Central Surgical Association: Changing attitudes in the management of cancer of the breast . Surgery 1978;84:441-447. 47. Massie FM, McClellan JT: An analysis of 1,500 breast biopsies . Am Surg 1960;26:509-515. 48. Storrs HG: The role of excision biopsy in lesions of the breast . Am Surg 1952;18:1199-1206. 49. George WD, Burn JI: Drill biopsy in the diagnosis of breast cancer . Clin Oncol 1975;1:291-295. 50. Elston CW, Cotton RE, Davis CJ, et al: A comparison of the use of the 'Tru-Cut' needle and fine needle aspiration cytology in the preoperative diagnosis of carcinoma of the breast . Histopathology 1978;2:239-254.Crossref 51. Roberts JG, Preece PE, Bolton PM: The 'Tru-cut' biopsy in breast cancer . Clin Oncol 1975;1:291-295. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Fine-Needle Aspiration of Palpable Breast Masses: A Program for Staged Implementation

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1983.01390070067013
Publisher site
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Abstract

Abstract • Fine-needle aspiration (FNA) can provide a morphologic diagnosis of palpable breast masses in an accurate, efficient, inexpensive, and safe manner. However, how one acquires the skill to perform the FNA and interpret the resulting smears, while protecting the patient from the risk of false-positive or false-negative results, is scarcely considered. We used a three-phase program to acquire experience with FNA while providing services for 205 patients over a 16-month period. We performed FNA sequentially in vitro, in vivo, and finally in vivo for clinical use. With available literature and this graduated implementation program, physicians totally inexperienced with FNA can achieve results similar to those of medical centers having experience with thousands of patients. (Arch Surg 1983;118:859-863) References 1. Franzen S, Zajicek J: Aspiration biopsy in diagnosis of palpable lesions of the breast: Critical review of 3,479 consecutive biopsies . Acta Radiol 1968;7:241-261.Crossref 2. Zajdela A, Ghossein NA, Pilleron JP, et al: The value of aspiration cytology in the diagnosis of breast cancer: Experience at the Fondation Curie . Cancer 1975;35:449-506.Crossref 3. Hajdu SI, Melamed MR: The diagnostic value of aspiration smears . Am J Clin Pathol 1973;59:350-356. 4. Strawbridge HTG, Bassett AA, Foldes I: Role of cytology in management of lesions of the breast . Surg Gynecol Obstet 1981;152:1-7. 5. Kline TS, Joshi LP, Neal HS: Fine-needle aspiration of the breast: Diagnoses and pitfalls: A review of 3,545 cases . Cancer 1979;44:1458-1464.Crossref 6. Kern WH: The diagnosis of breast cancer by fine-needle aspiration smears . JAMA 1979;241:1125-1127.Crossref 7. Koivuniemi AP: Fine-needle aspiration biopsy of the breast . Ann Clin Res 1976;8:272-283. 8. Zajicek J: Aspiration Biopsy Cytology . Basel, Switzerland, S Karger AG, 1974. 9. Schondorf H: Aspiration Cytology of the Breast . Philadelphia, WB Saunders Co, 1978. 10. Robbins GF, Brothers JH, Eberhart WF, et al: Is aspiration biopsy of breast cancer dangerous to the patient? Cancer 1954;7:774-778.Crossref 11. Berg JW, Robbins GF: A late look at the safety of aspiration biopsy . Cancer 1962;15:826-827.Crossref 12. Coel MN, Niwayama G: Safety of percutaneous fine-needle pancreatic biopsy: A porcine model . Invest Radiol 1978;13:547-549.Crossref 13. Duguid HID, Wood RAB, Irving AD, et al: Needle aspiration of the breast with immediate reporting of material . Br Med J 1979;2:185-187.Crossref 14. Fentimen IS, Millis RR, Hayward JL: Value of needle biopsy in outpatient diagnosis of breast cancer . Arch Surg 1980;115:652-653.Crossref 15. Fox CH: Innovation in medical diagnosis: The Scandinavian curiosity . Lancet 1979;1:1387-1388.Crossref 16. Koss LG: Thin needle aspiration biopsy of endocrine organs . Ann Clin Lab Sci 1979;9:326-332. 17. Koss LG: Thin needle aspiration biopsy . Acta Cytol 1980;24:1-3. 18. Frable WJ: Thin-needle aspiration biopsy: A personal experience with 469 cases . Am J Clin Pathol 1976;65:168-182. 19. Schour L, Chu EW: Fine needle aspiration in the management of patients with neoplastic disease . Acta Cytol 1974;18:472-476. 20. Coleman D, Desai S, Dudley H, et al: Needle aspiration of palpable breast lesions: A new application of the membrane filter technique and its results . Clin Oncol 1975;1:27-32. 21. Wilson SL, Ehrmann RL: The cytologic diagnosis of breast aspirations . Acta Cytol 1978;22:470-475. 22. Linsk J, Kreuzer G, Zajicek J: Cytologic diagnosis of mammary tumors from aspiration biopsy smears: II. Studies on 210 fibroadenomas and 210 cases of benign dysplasia . Acta Cytol 1972;16:130-138. 23. Kern WH, Dermer GB: Cytopathology of hyperplastic and neoplastic mammary duct epithelium . Acta Cytol 1972;16:120-129. 24. Kreuzer G: Aspiration biopsy cytology in proliferating benign mammary dysplasia . Acta Cytol 1977;22:128-132. 25. Wallgren A, Zajicek J: Cytologic presentation of mammary carcinoma on aspiration biopsy smears . Acta Cytol 1976;20:469-478. 26. Galen R, Gambino SR: Beyond Normality: The Predictive Value and Efficiency of Medical Diagnosis . New York, John Wiley & Sons Inc, 1975. 27. Sparkman RS: Reliability of frozen sections in the diagnosis of breast lesions . Ann Surg 1962;155:924-934.Crossref 28. Information 1981 . Tampa, Fla, American Board of Pathology, 1981. 29. Feldman JG, Carter AC, Nicastri AD, et al: Breast self-examination: Relationship to stage of breast cancer at diagnosis . Cancer 1981;47: 2740-2745.Crossref 30. Huguley CM, Brown RL: The value of breast self-examination . Cancer 1981;47:989-995.Crossref 31. McLoughlin MJ, Ho CS, Langer B, et al: Fine needle aspiration biopsy of malignant lesions in and around the pancreas . Cancer 1978;41: 2413-2419.Crossref 32. Sinner WN, Zajicek J: Implantation metastasis after percutaneous transthoracic needle aspiration biopsy . Acta Radiol 1976;17:473-479. 33. Ferrucci JT, Wittenberg J, Margolies MN, et al: Malignant seeding of the tract after thin-needle aspiration biopsy . Radiology 1979;130:345-346.Crossref 34. Engzell U, Jakobsson PÅ, Sigurdson Å, et al: Aspiration biopsy of metastatic carcinoma in lymph nodes of the neck: A review of 1,101 cases . Acta Otolaryngol 1971;72:138-147.Crossref 35. Engzell U, Esposti PL, Rubio C, et al: Investigation on tumour spread in connection with aspiration biopsy . Acta Radiol 1971;10:385-398.Crossref 36. Von Schreeb T, Arner O, Skovsted G, et al: Renal adenocarcinoma: Is there a risk of spreading tumour cells in diagnostic puncture? Scand J Urol Nephrol 1967;1:270-276.Crossref 37. Zajicek J: Fine-needle aspiration biopsy of palpable breast lesions , in Logan WW (ed): Breast Carcinoma . New York, John Wiley & Sons Inc, 1977, pp 319-324. 38. Kreuzer G, Zajicek J: Cytologic diagnosis of mammary tumors from aspiration biopsy smears: III. Studies on 200 carcinomas with false negative or doubtful cytologic reports . Acta Cytol 1972;16:249-252. 39. Holaday WJ, Assor D: Ten thousand consecutive frozen sections: A retrospective study focusing on accuracy and quality control . Am J Clin Pathol 1974;61:769-777. 40. Rosen PP: Frozen section diagnosis of breast lesions: Recent experience with 556 consecutive biopsies . Ann Surg 1978;187:17-19.Crossref 41. Patchefsky AS, Potok J, Hoch WS, et al: Increased detection of occult breast carcinoma after more thorough histologic examination of breast biopsies . Am J Clin Pathol 1973;60:799-804. 42. Rimsten A, Stenkvist B, Johanson H: The diagnostic accuracy of palpation and fine-needle biopsy and an evaluation of their combined use in the diagnosis of breast lesions . Ann Surg 1975;182:1-8.Crossref 43. Kreuzer G, Boquoi E: Aspiration biopsy cytology, mammography and clinical exploration: A modern set up in diagnosis of tumors of the breast . Acta Cytol 1976;20:319-323. 44. Kline TS: Masquerades of malignancy: A review of 4,241 aspirates from the breast . Acta Cytol 1981;25:263-266. 45. Nakazawa H, Rosen P, Lane N, et al: Frozen section experience in 3,000 cases: Accuracy, limitations, and value in residency training . Am J Clin Pathol 1968;49:41-51. 46. Lazaro EJ, Rush BF, Swaminathan AP: Central Surgical Association: Changing attitudes in the management of cancer of the breast . Surgery 1978;84:441-447. 47. Massie FM, McClellan JT: An analysis of 1,500 breast biopsies . Am Surg 1960;26:509-515. 48. Storrs HG: The role of excision biopsy in lesions of the breast . Am Surg 1952;18:1199-1206. 49. George WD, Burn JI: Drill biopsy in the diagnosis of breast cancer . Clin Oncol 1975;1:291-295. 50. Elston CW, Cotton RE, Davis CJ, et al: A comparison of the use of the 'Tru-Cut' needle and fine needle aspiration cytology in the preoperative diagnosis of carcinoma of the breast . Histopathology 1978;2:239-254.Crossref 51. Roberts JG, Preece PE, Bolton PM: The 'Tru-cut' biopsy in breast cancer . Clin Oncol 1975;1:291-295.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1983

References

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