Rational and cost-effective management of the patient with a solid breast lump

The rational management of the palpable breast lump requires a tissue diagnosis. The more conventional approach is biopsy under general anesthesia, examination of frozen sections and "follow-on" mastectomy when indicated. In the present study, we aimed at arriving at an unequivocal tissue diagnosis by studying permanent sections at a separate ambulatory procedure either with formal biopsy under local anesthetic or, in suspicious lumps, with the Trucut biopsy needle (Travenol Laboratories, Inc. USA). Only 7 (14%) of the 56 women with 64 breast lumps were hospitalized for biopsy under general anesthesia. In 13 out of 22 breast cancers, the definitive diagnosis was made by examining Trucut needle biopsy specimens. This alternative approach provides a significant reduction of costs, more efficient utilization of operating time and a fully evaluated, psychologically prepared patient, when mastectomy is indicated.