The results of fine-needle aspiration cytopathology were benign in 85 cases,
malignant in 11 cases, and atypical (not to be confused with atypical ductal
hyperplasia) in 21 cases, Dr. Buchbinder said. The patients with malignant
results underwent excisional biopsy, and the patients with atypical results
were advised to undergo excisional biopsy to verify the diagnosis. All of the
patients were advised to have mammograms at 6-month intervals.
The compliance with mammography at 6-month intervals was less than ideal.
About 25% of the patients underwent mammography at 6 months, 51% at 12 months,
21% at 18 months, and 97% at approximately 24 months, Dr. Buchbinder said. The
lesions were excised in three cases because the patients did not want to deal
with the uncertainty, he said.
During the entire 24-month mammographic follow-up in the 85 patients with
negative aspiration results, only one true false-negative aspiration result was
detected, Dr. Buchbinder said. "This small number somewhat limits the
ability to establish length of time before a malignant manifestation appears
but, at the same time, strongly supports the correctness of the initial
diagnosis," he said.
The missed cancer was detected on a mammogram performed at 12 months of
follow-up in a patient who had not had a mammogram at 6 months. This case
occurred early in the implementation of the ultrasound-guided fine-needle
aspiration program at Montefiore, Dr. Buchbinder noted, and they have since had
no known false-negative aspiration results.
The sensitivity, specificity, positive predictive value, and negative
predictive value of fine-needle aspiration plus mammography were all 100% at 12
months. The second year of follow-up after a negative result on aspiration did
not add any benefit, Dr. Buchbinder concluded.
"By 12 months, everybody who indeed had cancer was identified.
Conversely, all benign diagnosis, confirmed by the initial aspiration and
incorporating the follow-up 12-month mammography, proved to be benign at 12
months as well," he said.