Management of breast problems in gynecologic office practice using sonography and fine-needle aspiration

Breast-related problems were studied in 500 consecutive gynecologic patients by clinical assessment and mammography. Sonography and fine-needle aspiration were performed to clarify inconclusive clinical or mammographic findings. Cysts were correctly diagnosed by sonography in 175 of 189 patients (four of 193 with cysts had no ultrasound examination). Fine-needle aspiration provided immediate treatment in 116. Cysts were not aspirated in 75 patients, and two women required a biopsy because of atypical or suspicious cytologic changes. Carcinoma was detected in 23 patients; palpation was correctly positive in 15, sonography in 12 of 17, mammography in 18 of 22, and fine-needle aspiration in five of seven. We believe that sonography and fine-needle aspiration are useful extensions of the physical examination for benign breast disease, providing immediate diagnosis of cysts and facilitating the diagnosis of cancer. Our data, in agreement with the literature, indicate that no single method is completely reliable in diagnosing carcinoma. Therefore, a judicious combination of all available techniques should be used.