Unexpected Breast Cancer Detection after Outpatient Biopsy for Benign Lesion

Accuracy of Breast Cancer Diagnosis by Physical, Radiologic and Cytologic Combined Examinations

Physical examination, mammography and fine-needle aspiration cytology were performed in 1498 consecutive cases with a solitary solid lump of the female breast. The intent was to verify the validity of this diagnostic triplet in the accuracy of the preoperative diagnosis of breast cancer. Clinically sure cancers were excluded from the study. The collected data were evaluated in terms of sensitivity, specificity and predictivity of any procedure alone or in combination. In 1138 cases confirmed by histology (514 carcinomas and 669 benign or non-neoplastic lesions), the physical examination and mammography were very sensitive (respectively 96% and 84%) but with a high rate of false-positive reports (respectively 20% and 18%). The cytologic diagnosis was less sensitive (65%), mostly due to many inadequate smears, but highly specific (93%) and predictive for malignancy (99%) when the cytologic report was frankly positive. Any single procedure improved the overall sensitivity, and taken together this triplet appears to be the most effective noninvasive diagnostic combination that provides in a short time with minimal cost and discomfort, a diagnosis of certain malignancy in about 50% of carcinomas with a predictivity close to 100%, when cytology detected malignancy.

Diaphanography in benign breast disorders. Correlation with clinical examination, mammography, cytology and histology

Histologically classified benign breast disorder was present in 163 breast of 158 symptomatic women. The results of diaphanography (DPG) were correlated with those obtained by clinical examination (CE), mammography (M) and cytology (C). A tumour was palpable in 108 cases (66.3%). A false positive diagnosis, i.e. possibly malignant, probably malignant or malignant was made in 15 cases (9.2%) with DPG, and in 33 cases (20.2%) with M. Use of both M and DPG reduced the number of false positives to 1.8 per cent. In 8 cases (4.9%) false positive diagnosis was made with C. During a mean observation time of 58.5 months (range 44-72 months, one case of breast carcinoma was diagnosed.

A rationale for surgical detection of cancer without hospitalization

During 1980, in strict accordance with indication schedules outlined for breast, skin, oral cavity, lymph node, and soft tissue lesions, 2,499 patients were selected and operated on in the outpatient department of our institution. The main purpose was early detection of unexpected cancer without hospitalization. Of 1,266 breast operations, 99 (7.8%) unexpected carcinomas and 67 (5.3%) borderline or precancerous lesions were detected, with a higher rate of T1 and N- cases than were found in hospitalized breast carcinoma patients: T1, 61% vs 38%; N-, 68% vs 54%. The specimens of 1,048 skin and oral cavity lesions revealed 261 (24.9%) squamous or basal cell carcinomas, and most of them were cured by the outpatient surgery itself. Removal of 149 suspicious nevi revealed 20 (13.4%) unexpected malignant melanomas; 185 operations on lymph node and soft tissues detected 44 lymphomas (31 unexpected), 36 metastatic lymph nodes (five unexpected), and six sarcomas (five unexpected). These data confirm the validity of and necessity for surgical outpatient operations in selected cases.