Accuracy of fine needle aspiration biopsy of the breast.

Fine needle aspiration biopsy (FNAB) has become a widely used and accepted procedure to detect benign and malignant lesions of the breast. In the past, highly invasive procedures were used in the investigation of suspect breast tumors. Surgical excision was the method of choice during this period often requiring hospitalization of the patient. However, the recent introduction of FNAB has allowed a less traumatic approach for such investigations. Due to pressures from Health Management Organizations (HMO's), FNAB is presently the method of choice allowing for decreased patient trauma, expense, and ability of the procedure to be performed on an outpatient basis. Although highly accepted by most clinicians, others suggest that FNAB should perform diagnostically at a level equivalent or higher than that obtainable by frozen tissue sectioning procedures. This study was designed to evaluate the diagnostic ability of FNAB. Four-hundred twenty-seven patients underwent FNAB during 1993-94 at the University of Mississippi Medical Center. Of those patients, two hundred thirty-seven also underwent corresponding surgical biopsies. Sensitivity (88%), specificity (96%), a false positive rate (4%), and a false negative rate (12%) were calculated from the data and reported. In conclusion, the diagnostic accuracy of FNAB of the breast determined in this study shows the significance of the procedure.

Reactive cell change in cervicovaginal smears.

Reactive cell change in cervicovaginal smears is a controversial issue. The most common criteria for reactive cell change include an increase in nuclear size, presence of nucleoli, binucleation, cytoplasmic vacuolization, and polychromasia. The purpose of this study is to define, as specifically as possible, the criteria of reactive cell change. Sixty-one cervicovaginal smears in a routine examination obtained during 1988 to 1994 were reviewed for this study. All cases had been diagnosed as reactive. Fifty-three of these were re-diagnosed as reactive and 8 cases were rediagnosed as negative. Inflammatory cells were present in 79% and organisms involvement such as Herpes, Trichomonas, Chlamydia, Gardnerella, and Candida were present in 23% percent. The smears were also evaluated for cellular arrangement, origin of the reactive cells, and presence of nucleoli. The majority of reactive cells were found in aggregates and were of metaplastic origin. Nucleoli were present in 85% of the cases. In all cases the most important criteria of reactive cell change were found to be aggregates of metaplastic cells with central nuclei containing nucleoli and a fine chromatin pattern, followed by the presence of organisms. Additionally, the majority of cases with a cytology diagnosis of reactive cell change had a squamous intraepithelial lesion on biopsy. In conclusion, this study suggests that follow-up Pap smears over a two year period may revert to normal in some of the cases.