Ultrasound-Guided FNA Found to Be Highly Accurate

PARIS, France--Ultrasound-guided fine-needle aspiration (FNA)cytology has emerged as a highly accurate approach to diagnosingoccult 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 atenth as much as needle-localized open biopsy.

"One of the most difficult problems we have as surgeons andoncologists is determining what really constitutes a suspiciousmammogram," Dr. Frazier said at the American Radium Societyannual meeting.

The only true diagnostic feature is a spiculated border, he said,and given the relatively low incidence of malignancy, even advancedneedle localization and biopsy and stereotactic techniques areless than optimum.

The Pennsylvania study included 166 consecutive patients witha nonpalpable breast mass and a new or suspicious mammographiclesion that did not meet ultrasound criteria for a simple cyst.

In this group, ultrasound-guided fine-needle aspiration cytologyshowed that four fifths had either a complex cyst or fibrocysticchanges, 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 earlydiagnosis provides the patient with options for primary therapy."He also underscored the absence of any false-negative cytologicresults on 3-month follow-up examination.

The total cost of ultrasound-guided fine-needle biopsy in thisstudy 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.

"We have not yet compared this with stereotactic biopsy,"he said, "but for needle-localized open biopsy, our chargesare approximately $5,370 per case," he said, which includesall technical, hospital, anesthesiology, radiology, pathology,and surgical charges.

"We think ultrasound-guided fine-needle aspiration cytologyis a logical first step in the diagnosis of breast cancer thatis heralded by a suspicious mammogram," Dr. Frazier said,"and we're anxious to complete our studies of this."