SEATTLEA 1-year follow-up with mammography appears to be
sufficient to detect any false-negative results of ultrasound-guided
fine-needle aspiration in patients with nonpalpable breast masses, according to
a study from the Montefiore Medical Center, Bronx, NY. Shalom Buchbinder, MD,
director of mammography, presented the study at the 101st Annual Meeting of the
American Roentgen Ray Society.
The retrospective study evaluated the necessity for the currently
recommended but controversial 2-year follow-up. These 2 years are often a time
of anxious uncertainty for patients and physicians alike, Dr. Buchbinder said.
A shorter follow-up would be preferableprovided that it caught any
false-negative results of fine-needle aspiration.
"Essentially, we wanted to see how long it would take for our
false-negative aspirations to manifest themselves with malignancy," he
The researchers reviewed all of the cases of nonpalpable masses detected by mammograms or sonograms and sampled by
ultrasound-guided fine-needle aspiration between January 1995 and March 1998.
The sampling was performed with a 25- or 27-gauge needle under ultrasound
guidance, and the samples were immediately handed to a cytopathologist, who
prepared the slides and made an initial and final interpretation (benign,
malignant, or atypical).
"This triad of mass lesions only, ultrasound guidance, and on-site,
specialized cytopathologists is really necessary in order to maximize the
correct diagnosis of these fine-needle aspirations," Dr. Buchbinder
emphasized in his talk.
The investigators did not use fine-needle aspiration to sample
microcalcifications because these lesions often represent heterogeneous
populations of cells, and aspiration harvests only a small sample. In contrast,
samples from masses allow greater diagnostic certainty. "We assume that a mass has a
relatively homogeneous population of cells and that any harvesting from that
mass will be representative of that mass," he said.
Specialized cytopathologists are also essential for the success of an
ultrasound-guided fine-needle aspiration program. "We are fortunate at
Albert Einstein-Montefiore that we have a group that initially trained at the
Karolinska Institute in Sweden, which is one of the preeminent cytopathology
centers in the world," he said.