Role of aspiration cytology in the diagnosis and management of mammary lesions in office practice.

Sixteen hundred and eighty breast aspiration specimens obtained from 1410 patients seen in office practice were reviewed. The cytologic diagnosis was unsatisfactory in 230 cases, benign in 1019 cases, atypical in 198 cases, suspicious for malignancy in 102 cases, and malignant in 131 cases. All cases diagnosed as cytologically malignant had a subsequent tissue diagnosis of malignant neoplasm. Four percent of the cytologically benign cases and 17% of the cytologically atypical cases had malignant neoplasms. Clinical and cytologic examination detected more cancers (87%) than did clinical and mammographic examination (79%). Ninety-three percent of malignant neoplasms were detected by the combination of clinical, cytologic, and mammographic examination. Aspiration cytology significantly contributes to the clinical evaluation of mammary lesions in office practice, but it does not replace tissue biopsy or careful follow-up of mammary lesions of clinical concern. Proof of the presence of breast cancer by aspiration in the office may obviate the need for a two-stage procedure in the surgical management of breast cancer. Aspiration of minimally suspicious lesions often is helpful in initiating excisional biopsy in some occult, clinically unrecognized breast cancers.