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Analysis of residual cancer after diagnostic breast biopsy: An argument for fine-needle aspiration cytology

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Abstract

Background: Diagnostic breast biopsy (DxBx) requires an effective strategy for strategy for successful treatment of breast cancer by lumpectomy or mastectomy. Clearance of margins is required to achieve local control.

Methods: We reviewed 844 malignant diagnostic biopsies. The strategy was to perform DxBx on all nonpalpable lesions and fine-needle aspiration (FNA) on all palpable lesions. When FNA was equivocal, DxBx was performed. After positive DxBx, either the biopsy cavity or FNA-positive breast mass was excised, and margins were documented with touch preparation cytology analysis (TPC) and frozen section (FS) as necessary to achieve negative margins.

Results: Ourside institutions referred 430 excisional biopsies. Two hundred twenty-five (52.3%) were found to have residual cancer at surgical excision. Our institution performed 414 biopsies: 169 were performed on nonpalpable lesions in which 58% had residual tumor at resection; 245 were diagnosed by FNA of palpable lesions. Residual disease was found in 12 (5%).

Conclusions: Of patients who undergo DxBx, >50% have residual breast cancer. It is recommended that (a) FNA be performed on all palpable masses or DxBx of nonpalpable masses; when cancer is diagnosed, proceed to surgical excision. (b) When lumpectomy is the option, margins should be reexcised and intraoperatively evaluated with TPC and FS at the time of axillary dissection.

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References

  1. Fisher B, Redmond C, Poisson R, Margolese R, Wolmark N, Wickerham L, Fisher E. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer.N Engl J Med 1989;320:822–8.

    CAS  PubMed  Google Scholar 

  2. Harris JR, Connolly JL, Schnitt SJ, Cady B, Love S, Osteen RT, Patterson WB. The use of pathologic features in selecting the extent of surgical resection necessary for breast cancer patients by primary radiation therapy.Ann Surg 1985;201:164–9.

    CAS  PubMed  Google Scholar 

  3. Lagios MD, Richard VE, Rose MR, Yee E. Segmental mastectomy without radiotherapy.Cancer 1983;52:2173–9.

    CAS  PubMed  Google Scholar 

  4. Esselstyn CB Jr. Biopsy techniques in the diagnosis of breast cancer. In:Controversies in breast disease: diagnosis and management. Grundfest-Broniatowski S, Esselstyn CB Jr, eds. New York: Marcel Dekker:215–7.

  5. Homer MJ, Schmidt-Ullrich R, Safaii H, Pile-Spellman ER, Marchant DJ, Smith TJ, Kelly K. Residual breast carcinoma after biopsy: role of mammography in evaluation.Radiology 1989;170(1 Pt 1):75–7.

    CAS  PubMed  Google Scholar 

  6. Solin LJ, Fowbel B, Martz K, Pajak TF, Goodman RL. Results of re-excisional biopsy of the primary tumor in preparation for definitive irradiation of patients with early stage breast cancer.Int J Radiat Oncol Biol Phys 1986;12(5):721–5.

    CAS  PubMed  Google Scholar 

  7. Shidham VB, Dravid NV, Grover S, Kher AV. Role of scrape cytology in rapid intraoperative diagnosis.Acta Cytol 1976;20:553–5.

    Google Scholar 

  8. England DW, Chan SY, Lee MJ. Assessment of margins following excision of breast carcinoma: a comparison between specimen scrape cytology and tumor bed biopsy.Br J Cancer 1990;62:(suppl 12):13.

    Google Scholar 

  9. Cox CE, Ku NN, Reintgen DS, Greenberg HM, Nicosia SV, Wangensteen S. Touch preparation cytology of breast lumpectomy margins with histologic correlation.Arch Surg 1991;126:490–3.

    CAS  PubMed  Google Scholar 

  10. Ngai JH, Zelles GW, Rumore GJ, Sawicki JE, Godfrey RS. Breast biopsy techniques and adequacy of margins.Arch Surg 1991;126(11):1343–7.

    CAS  PubMed  Google Scholar 

  11. Lannin DR, Silverman JF, Walker C, Pories WJ. Cost-effectiveness of fine needle biopsy of the breast.Ann Surg 1986;203(5):474–80.

    CAS  PubMed  Google Scholar 

  12. Silverman JF, Lannin DR, O'Brien K, Norris HT. The triage role of fine needle aspiration biopsy of palpable breast masses. Diagnostic accuracy and cost-effectiveness.Acta Cytol 1987;31(6):731–6.

    CAS  PubMed  Google Scholar 

  13. Wanebo HJ, Feldman PS, Wilhelm MC, Covell JL, Binns RL. Fine needle aspiration cytology in lieu of open biopsy in management of primary breast cancer.Ann Surg 1984;199(5):569–79.

    CAS  PubMed  Google Scholar 

  14. Schain W, Edwards BK, Gorrell CR, de Moss EV, et al. Psychosocial and physical outcomes of primary breast cancer therapy; mastectomy vs excisional biopsy and irradiation.Breast Cancer Res Treat 1983;3(4):377–82.

    Article  CAS  PubMed  Google Scholar 

  15. Hughson AV, Cooper AF, McArdle CS, Smith DC. Psychosocial morbidity in patients awaiting breast biopsy.J Psychosom Res 1988;32(2):173–80.

    Article  CAS  PubMed  Google Scholar 

  16. Roberts CS, Elkins NE, Cox CE, Baile WB. Integrating research with practice; the psychosocial impact of breast cancer.Health Soc Work 1989;14:261–8.

    CAS  PubMed  Google Scholar 

  17. Schain WS. Physician-patient communication about breast cancer: a challenge for the 1990's.Surg Clin North Am 1990;70:917–36.

    CAS  PubMed  Google Scholar 

  18. Nattinger MD, Gottlieb PhD, Veum BS, Yahnke MD, Goodwin MD. Geographic variation n the use of breast conserving treatment for breast cancer.N Engl J Med 1992;326:1147–9.

    Google Scholar 

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Authors and Affiliations

  1. From the Department of Surgery, University of South Florida College of Medicine and the H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA

    Charles E. Cox MD (Associate Professor of Surgery), Douglas S. Reintgen MD & Larry C. Carey MD

  2. the Department of Pathology, University of South Florida College of Medicine and the H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA

    Santo V. Nicosia MD, Ni Ni Ku MD & Paul Baekey MD

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  1. Charles E. Cox MD
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  2. Douglas S. Reintgen MD
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  3. Santo V. Nicosia MD
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  4. Ni Ni Ku MD
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  5. Paul Baekey MD
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  6. Larry C. Carey MD
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Cox, C.E., Reintgen, D.S., Nicosia, S.V. et al. Analysis of residual cancer after diagnostic breast biopsy: An argument for fine-needle aspiration cytology. Annals of Surgical Oncology 2, 201–206 (1995). https://doi.org/10.1007/BF02307024

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  • DOI: https://doi.org/10.1007/BF02307024

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