The diagnostic accuracy of palpation and fine-needle biopsy and an evaluation of their combined use in the diagnosis of breast lesions: report on a prospective study in 1244 women with symptoms.

In 1244 women with breast symptoms an evaluation by means of palpation was made with respect to diagnosis of malignancy according to a four-grade scale ranging from "definite cancer" to "no cancer." Aspiration biopsy and cytologic examination were then performed in 984 breast lesions. The diagnosis from the cytologic evaluation ranged from benign, through three grades of atypia (slight, moderate, grave) to cancer. A histologic diagnosis was made in 411 cases and in 28% it was cancer. Cancer was found in 92.5% of the patients with a palpatory diagnosis of "definite cancer," and in 50% of those with a palpatory diagnosis of "strong suspicion of cancer." In all patients in whom cancer was diagnosed cytologically, the same diagnosis was made at histology, while 87.5% of those with grave atypia at the cytologic examination were diagnosed histologically as having cancer. A false negative cytologic diagnosis was made in 4% of the cancer cases. With a combination of palpation and cytology, 91% of the cancer cases fell within the groups "definite cancer," "strong suspicion of cancer" (palpation)/"cancer," "grave atypia" (cytology). No patients with cancer were evaluated as "no cancer" (palpation)/"no atypia" (cytology). In this group of 697 patients, however, one cancer was discovered after 7 months. The investigation showed that a thorough palpatory evaluation is a prerequisite for a good result of aspiration biopsy, in particular to meet the risk of a false negative cytologic diagnosis. The cytologic examination revealed cancer in 6 and 12 cases, respectively, when palpation gave no or some suspicion of cancer, and in many cases it was able to eliminate malignancy suspected on palpation. Cytologic atypia indicated cancer in a relatively high per cent, but was also noted in many cases found to be benign histologically. The possibilities of reducing the number of "unnecessary" surgical biopsies by using a combination of palpation and cytology is discussed.