Needle biopsies in breast cancer diagnosis: techniques in search of an audience

Fine-needle aspiration cytology and Tru-cut needle biopsy have been described as excellent techniques in the diagnosis of breast cancer. Responses to questionnaires sent to 90 pathologists in San Diego County, however, proved that in only 2-10% of all new breast cancer cases are these techniques being used to make the initial diagnosis. This paradox appeared to be due mainly to a reluctance of clinicians to use these techniques. However, there also appeared to be a lack of confidence and training among pathologists in interpreting aspiration cytology specimens. In the authors' and other pathologists' opinion, reviewing breast aspiration cytology specimens requires special training and regular exposure to such material, whereas Tru-cut needle biopsy specimens can be interpreted accurately by almost any pathologist without special training. The results of our own series of needle biopsies and aspiration cytology in the diagnosis of breast cancer are presented and compared to those reported in several other published reports. These data indicate that approximately 90% (89% in our series) of all palpable breast cancers can be diagnosed by needle biopsy techniques.