PARIS, France--Ultrasound-guided fine-needle aspiration (FNA) cytology has emerged as a highly accurate approach to diagnosing occult breast malignancies in women with suspicious mammograms, said Thomas Frazier, MD, of the Medical College of Pennsylvania. What's more, he said, the ultrasound method costs less than a tenth as much as needle-localized open biopsy.
"One of the most difficult problems we have as surgeons and oncologists is determining what really constitutes a suspicious mammogram," Dr. Frazier said at the American Radium Society annual meeting.
The only true diagnostic feature is a spiculated border, he said, and given the relatively low incidence of malignancy, even advanced needle localization and biopsy and stereotactic techniques are less than optimum.
The Pennsylvania study included 166 consecutive patients with a nonpalpable breast mass and a new or suspicious mammographic lesion that did not meet ultrasound criteria for a simple cyst.
In this group, ultrasound-guided fine-needle aspiration cytology showed that four fifths had either a complex cyst or fibrocystic changes, while the remaining one fifth had true solid lesions, roughly half of which proved to be malignant.
"Most important," Dr. Frazier said, "almost 60% of these malignant lesions were under 1 cm in size, and such early diagnosis provides the patient with options for primary therapy." He also underscored the absence of any false-negative cytologic results on 3-month follow-up examination.
The total cost of ultrasound-guided fine-needle biopsy in this study was $478 per patient, including the cytopathologist's charge, the surgeon's fee for doing the aspiration, the ultrasound charge, and the technician charge for preparing the cytology slide, Dr. Frazier reported.