1. Fine-needle aspiration of clinically suspicious palpable breast masses with histopathologic correlation
Reshma Ariga, M.D., Kenneth Bloom, M.D., Vijaya B. Reddy, M.D., Larry Kluskens, M.D., Darius Francescatti, M.D., Kambiz Dowlat,M.D., Popi Sizipikou, M.D., Paolo Gattuso, M.D.

2. I. Introduction
Fine-needle aspiration (FNA) cytology by Martin and Ellis - diagnosis of palpable breast mass - sensitive - specific - economical - safe - part of diagnostic triad: - clinical breast exam - mammography

3. II. Objectives
Study and compare the accuracy of FNA performed in women with breast tumors who were younger and older than 40 years.
To determine whether the patient’s age was pertinent while interpreting a FNA.

4. III. Methodology
Patients: retrospective search of 1,158 FNA biopsies for clinically palpable breast mass at Rush Presbyterian St. Luke’s Medical center and Loyola University Medical Center between 1982 and 2000.
Group 1: 231 women younger than 40
Group 2: 927 women 41 and older

5. III. Methodology
Histopathologic diagnoses, based on needle core biopsy, excisional biopsy or mastectomy
FNA’s by pathologists: 23-gauge needle, 10mL syringe mounted on an aspiration device.
Smears fixed in alcohol
Stained with papanicolaou stain
Smears were air dried
Stained with the Diff-quick method for immediate evaluation

8. III. Methodology Malignant – presence of cancerous cells
Benign – absence of cancerous cells
Suspicious – suggestive cytologic features but did not completely fulfill the criteria of being malignant
- Cytologic material not fixed well

9. III. Methodology
Sensitivity, specificity, positive predictive value, negative predictive value, false negative rate and false positive rate were calculated for group 1, group 2, and the entire cohort.

10. IV. Results Group 1 Group 2 40 years and younger 231/ 1,158 patients
41 years and older
927/ 1,158 patients

11. Group 1: FNA Diagnosis Malignant Diagnosis Benign Diagnosis
117 patients
1 false positive (atypical papillomatosis)
positive predictive value = 99%
Benign Diagnosis
91 patients
1 false negative (infiltrating ductal carcinoma)
negative predictive value = 99%

12. Group 1: FNA Diagnosis Suspicious Diagnosis Histopathology 20 patients
10 malignant
10 benign

13. Group 1: FNA Diagnosis
Overall sensitivity
99%
Overall specificity

14. Group 2: FNA Diagnosis Malignant Diagnosis 693 patients
3 false positives (2 atypical ductal hyperplasia & 1 atypical papilloma)
positive predictive value = 99%
Benign Diagnosis
131 patients
18 false negatives (13 infiltrating ductal carcinoma, 4 infiltrating lobular carcinoma & 1 ductal carcinoma in-situ)
negative predictive value = 86%

15. Group 2: FNA Diagnosis Suspicious Diagnosis Histopathology 90 patients
68 malignant
22 benign

16. Group 2: FNA Diagnosis
Overall sensitivity
98%
Overall specificity
97%

17. V. Summary

18. VI. Appraisal The objectives of the study are clearly stated.
The study design is suitable for the objectives.
The subjects used were the right sample to answer the objectives.
The study is large enough to achieve its objectives.
All subjects were accounted.
The results are presented clearly, objectively and in sufficient detail to enable readers to make their own judgment.
The author's conclusions are justified by the data.
The results of the study can be applied locally.