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The application of fine-needle aspiration biopsy (FNAB) to the diagnosis of nonpalpable breast lesions was evaluated with a new method which uses standard needle localization under mammographic guidance to assure accurate sampling by FNAB. This method was prospectively applied to 100 mammographically detected breast lesions in 100 women (mean age, 53 years). All 100 patients underwent surgical excision of these nonpalpable lesions after cytologic aspiration. Sufficient aspirated material was obtained for cytologic diagnosis from 91 patients (91%). The histologic and cytologic interpretations were then compared. Twenty malignancies were ultimately diagnosed by histology (12 invasive ductal carcinoma, six ductal carcinoma in situ, and two lobular carcinoma in situ), of which 17 had been cytologically diagnosed. There were no false-positive diagnoses of malignancy by FNAB. False-negative readings (3.3%) included two cases of lobular carcinoma in situ and one case of ductal carcinoma in situ. This technique thus demonstrated a sensitivity of 85%, specificity of 100%, and overall diagnostic accuracy of 96.7% for the nonsurgical detection of malignancy in nonpalpable breast lesions. These results suggest that the established safety, reliability, and cost-effectiveness of FNAB can be maintained in this clinical setting. This procedure may obviate the need for open surgical biopsy in those patients with an unequivocal diagnosis of malignancy. It can also be done using standard techniques and equipment available in many community hospitals.

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Nonpalpable breast lesions in 20 female patients were prospectively evaluated with a new technique of fine-needle aspiration biopsy (FNAB) under mammographic guidance. The patient age range was 37-82 years (mean: 60 years), and the mammographic indications for biopsy were microcalcifications (30%), mass (30%), mass with calcifications (25%), and asymmetric density (15%). Seven (35%) patients had significant risk factors for breast cancer. Prototype coaxial 19-gauge/22-gauge and 18-gauge/20-gauge needle systems (Cook, Inc., Bloomington, IN) were used for localization and biopsy. The technique involved needle localization of the target lesion with FNAB performed through the localizing needle after radiologic confirmation of position. A localizing wire then was inserted to allow each patient to proceed directly to the operating room for a standard needle localization open biopsy. Successful localization and aspiration was possible in 18 (90%) patients. Surgical excision was performed in all 20 patients and confirmed by specimen radiography in 17 (85%). A significant concordance of 94 per cent was found between the histologic results of the open biopsy specimens and the cytologic findings of aspirated specimens. These findings suggest that mammographically guided FNAB may offer a safe, reliable, and cost-effective alternative to open biopsy of nonpalpable breast lesions. Further study of this procedure is warranted to confirm its potential in this area.

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We retrospectively reviewed 54 consecutive children (mean age, 12 years) evaluated for possible appendicitis to determine the efficacy of laboratory and radiologic procedures in establishing the diagnosis. The final diagnosis was appendicitis in 24 and abdominal pain not necessitating operation in the remaining 30. Two hundred two laboratory tests were obtained (average 3.7 tests per patient). The mean white blood cell count on initial CBC was 13,930/cu mm overall with a higher mean in the appendicitis group (16,704 vs 11,057/cu mm). Of the 148 tests besides CBC, only 12 (8%) yielded abnormal results; all of these were present on urinalysis and were nondiagnostic. A total of 117 roentgenograms were obtained on initial evaluation (average 2.2 x-ray films per patient). Films were considered abnormal by the ordering physician in 12 cases (24%). When reviewed by the radiologist, 17 abnormalities (33%) were detected. In only seven instances was there agreement in interpretation of abnormality between the ordering physician and the radiologist. This review indicates little usefulness of nonspecific laboratory and radiologic evaluation of possible appendicitis in children. Appendicitis remains a diagnosis of physical examination, and early referral with thorough evaluation by an experienced examiner may result not only in improved accuracy, but in less delay in appropriate therapy, with greater cost effectiveness.

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