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Medical Oncology and Tumor Pharmacotherapy

, Volume 8, Issue 3, pp 169–174 | Cite as

Breast cancer: Early diagnosis of precursor lesions and clinically inapparent carcinoma by fine needle aspiration

  • Joseph A. Linsk
Article
  • 16 Downloads

Abstract

Breast cancer death rate has remained stable at 26 per 100,000 for over 50 years. This control failure is due in large part to difficulty in early diagnosis.

Combined clinical evaluation, mammography and fine needle aspiration (FNA) offer the best opportunity for early diagnosis. Non-directed FNA is a useful adjunctive technique and three illustrative cases are presented. Cancer evolves from proliferative epithelial disease of ducts and lobules. Atypical duct hyperplasia in association with family history is a pertinent marker for development of cancer.

Identification of hyperplastic lesions traditionally occurs after surgical biopsy and histopathologic review. FNA demonstrates patterns of both duct hyperplasia and atypical duct hyperplasia. Ploidy studies of such smears offer the possibility of selecting precancerous lesions for extirpation. A combination of directed and undirected punctures and ploidy studies may yield early diagnosis of precancerous lesions.

Key words

Breast cancer Precursor lesions FNA Duct hyperplasia Occult malignancy 

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References

  1. 1.
    Ca —A Cancer Journal for Clinicians 41, 26 (1991).Google Scholar
  2. 2.
    Strax P: The Health Insurance Plan of New York study.Cancer (Suppl)64, 2641 (1989).PubMedCrossRefGoogle Scholar
  3. 3.
    Kreuzer G, Boquoi E: Aspiration biopsy cytology, mammography and clinical exploration: a modern setup in diagnosis of tumors of the breast.Acta Cytol 20, 319 (1976).PubMedGoogle Scholar
  4. 4.
    Hermansen C, Poulsen H S, Jensen J, Langfeldt B, Steenskov V, Frederiksen P, Jensen O M: Diagnostic reliability of combined physical examination, mammography and fine-needle puncture (“Triple Test”) in breast tumors.Cancer 60, 1866 (1987).PubMedCrossRefGoogle Scholar
  5. 5.
    Cady B: New diagnostic, staging and therapeutic aspects of early breast cancer.Cancer 65, 634 (1990).PubMedCrossRefGoogle Scholar
  6. 6.
    Tavassoli F A, Norris H J: A comparison of the results of long term follow-up for atypical intraductal hyperplasia and intraductal hyperplasia of the breast.Cancer 65, 518 (1990).PubMedCrossRefGoogle Scholar
  7. 7.
    Page D L, Dupont W D: Anatomic markers of human premalignancy and risk of breast cancer.Cancer 66, 1326 (1990).PubMedCrossRefGoogle Scholar
  8. 8.
    Kritchevsky D: Nutrition and breast cancer.Cancer 66, 1321 (1990).PubMedCrossRefGoogle Scholar
  9. 9.
    McGinnis L S: The importance of clinical breast examination.Cancer (Suppl)64, 2657 (1989).Google Scholar
  10. 10.
    Linsk J A, Franzen’ S:Fine-Needle Aspiration for the Clinician. Philadelphia, J B Lippincott (1986).Google Scholar
  11. 11.
    Shapiro S, Venet W, Strax P, Venet L, Roeser R: Ten-to-fourteen year effect of screening on breast cancer mortality.J natn Cancer Inst 69, 349 (1982).Google Scholar
  12. 12.
    U.K. Trial of Early Detection of Cancer Group: First results on mortality reduction in the U.K. trial of early detection of breast cancer.Lancet ii, 411 (1988).Google Scholar
  13. 13.
    Morrison A S: Review of evidence on the early detection and treatment of breast cancer.Cancer (Suppl)64, 2651 (1989).Google Scholar
  14. 14.
    Winchester D P; Evaluation and management of breast abnormalities.Cancer 66, 1345 (1990).PubMedCrossRefGoogle Scholar
  15. 15.
    Azevedo E, Svane G, Auer G: Stereotactic fine- needle biopsy in 1594 mammographically detected non-palpable lesions.Lancet 1033 (1989).Google Scholar
  16. 16.
    Urbanski S, Jensen H M, Cooke G: The association of histological and radiological indicators of breast cancer risk.Er J Cancer 58, 474 (1988).Google Scholar
  17. 17.
    Bartow S A, Pathak D R, Mettler F A: Radiographic microcalcification and parenchymal pattern as indicators of histologic “high risk” benign breast disease.Cancer 66, 1721 (1990).PubMedCrossRefGoogle Scholar
  18. 18.
    Franzen’ S, Zajicek J: Aspiration biopsy in diagnosis of palpable lesions of the breast. Critical review of 3479 consecutive biopsies.Acta Radiol (ther) 7, 241 (1968).Google Scholar
  19. 19.
    Linsk J A, Franzen’ S: Breast aspiration, in Linsk J A, Franzen’ S (ed):Clinical Aspiration Cytology, p. 111. Philadelphia, J. B. Lippincott (1989).Google Scholar
  20. 20.
    Sneige N, White V A, Katz R L, Troncoso P, Lipshitz H, Hortobagy G N: Ductal carcinomain situ of the breast. Fine-needle aspiration cytology of 12 cases.Diag Cytopath 5, 371 (1989).CrossRefGoogle Scholar
  21. 21.
    Stanley M W, Tani E M, Skoog L: Fine-needle aspiration of fibroadenomas of the breast with atypia.Diag Cytopath 6, 375 (1990).CrossRefGoogle Scholar
  22. 22.
    Marshall C J, Schumann B, Ward J H, Riding J M, Cannon-Albright L, Skolnick M: Cytologie identification of clinically occult proliferative breast disease in women with a family history of breast cancer.Am J clin Path 95, 157 (1991).PubMedGoogle Scholar
  23. 23.
    Kern W H, Dermer G B: The cytopathology of hyperplastic and neoplastic mammary duct epithelium.Acta Cytol 16, 120 (1972).PubMedGoogle Scholar
  24. 24.
    Zajicek J: Breast, in Zajicek J (ed):Aspiration Biopsy Cytology, p. 136. Basel, S. Karger (1974).Google Scholar
  25. 25.
    Bibbo M, Scheiber M, Cajulis R, Keebler C M, Wied G L, Dowlatshahi K: Stereotaxic fine needle aspiration cytology of clinically occult malignant and premalignant breast lesions.Acta Cytol 32, 193 (1988).PubMedGoogle Scholar
  26. 26.
    Linsk J A, Kreuzer G, Zajicek J: Cytologic diagnosis of mammary tumors from aspiration biopsy smears: II. Studies of 210 fibroadenomas and 210 cases of benign mammary dysplasia.Acta Cytol 16, 130 (1972).PubMedGoogle Scholar
  27. 27.
    Bondeson L, Lindholm K: Aspiration cytology of tubular breast carcinoma.Acta Cytol 34, 15 (1990).PubMedGoogle Scholar
  28. 28.
    Ewing J: Precancerous diseases and precancerous lesions, especially in the breast.Med Rec 86, 951 (1914).Google Scholar
  29. 29.
    Rogers L W, Page D L: Epithelial proliferative disease of the breast — a marker of increased cancer risk in certain age groups.Breast 5, 2 (1979).Google Scholar
  30. 30.
    Page D L, Dupont W D: Anatomic markers of human premalignancy and risk of breast cancer.Cancer 66, 1326 (1990).PubMedCrossRefGoogle Scholar
  31. 31.
    Kodlin D, Winger D E, Morganstern N L, Chen U: Chronic mastopathy and breast cancer.Cancer 39, 2603 (1977).PubMedCrossRefGoogle Scholar
  32. 32.
    Hutchinson W B, Thomas D B, Hamlin W B, Roth G I, Peterson A V, Williams B: Risk of breast cancer in women with benign breast disease.J natn Cancer Inst 65, 13 (1980).Google Scholar
  33. 33.
    Page D L, Dupont W D, Rogers L W: Ductal involvement by cells of atypical lobular hyperplasia in the breast — a long; term follow-up study of cancer risk.Human Pathol 19, 201 (1988).CrossRefGoogle Scholar
  34. 34.
    Dupont W D, Page D L: Risk factors for breast cancer in women with proliferative breast disease.New Engl J Med 312, 146 (1985).PubMedGoogle Scholar
  35. 35.
    Gould D W, Moralis A R: Breast, in Hensen D E and Albores-Saavedra J (ed):The Pathology of Incipient Neoplasia, p. 233. Philadelphia, W. B. Saunders (1986).Google Scholar
  36. 36.
    Fentiman I S:Detection and Treatment of Early Breast Cancer. Philadelphia, J. B. Lippincott (1990).Google Scholar
  37. 37.
    Teplitz R L, Butler B B, Tesluk H, Min B H, Russell L A, Jensen H M, Hill L R: Quantitative DNA patterns in human preneoplastic breast lesions.Anal quant Cytol Histol 12, 98 (1990).PubMedGoogle Scholar

Copyright information

© Humana Press Inc. 1991

Authors and Affiliations

  • Joseph A. Linsk
    • 1
  1. 1.Atlantic City Medical CenterAtlantic CityUSA

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