The gynecologist and surgical procedures for breast disease

Patients with a palpable mass often benefit most from aspiration. As the clinician tries to aspirate, fluid may be obtained if the lesion is cystic. A solid lesion can be assessed with FNA biopsy with a very high degree of accuracy. Excisional biopsy should be used when a cystic lesion recurs, the mass does not disappear after the cyst is aspirated, or if the fluid obtained is bloody. A solid lesion may need to be excised if the aspirate is negative. The overall detection rate of breast cancer is approximately 20% for excisional biopsies. Mammographically detected lesions can be evaluated with needle-localization biopsies and stereotactic biopsies. The detection rates for breast carcinoma averages approximately 30%, with at least 20% of these lesions being noninvasive. The role of core needle biopsy of palpable lesions is limited; however, histologic confirmation of positive cytologic results from aspirate is possible with this approach. Stereotactic needle biopsy appears to correlate well with the specimen obtained at incisional biopsy and may decrease the need for needle-localized excisional biopsy.