Combined assessment (aspiration cytology and mammography) of clinically suspicious breast masses.

We examined the safety and utility of the combined assessment of aspiration cytology and mammography in 705 women who had clinically suspicious or malignant palpable breast masses. Histological assessment confirmed 176 benign and 529 malignant lesions. There were no incorrect (false positive) diagnoses made in the 176 benign masses when combined assessment was used (specificity 1.0; predictive value 0.86); in isolation, however, there was a false positive cytological diagnosis ('papillary carcinoma') and 3 false positive mammographic diagnoses. Benign disease (false negative) was incorrectly diagnosed by combined assessment in 4 of the 529 malignant masses (sensitivity 0.99; predictive value 0.98): cytological diagnoses were of fat necrosis (2) and benign cells on cytospin (1) and aspiration biopsy (1); mammographic diagnoses were of benign disease (2) and normality (2). Indeterminate ('atypical', 'suspicious') diagnoses were problematic and frequent (overall 223 (31.6%), malignant masses 137 (25.9%), benign masses 86 (48.9%); cytology 117 (16.6%), mammography 141 (20%). Thus, with the combined assessment of mammography and cytology in clinically suspicious breast masses, a decisive diagnosis was made in about two-thirds of cases allowing the safe commencement of therapy; the balance of patients required core or excision biopsy.