title: The negative predicative value of breast fine-needle aspiration biopsy: the Massachusetts General Hospital experience.
abstract: Breast fine-needle aspiration biopsy (FNAB) has been increasingly accepted as an important triage tool for the evaluation of breast lumps. We examined the clinical utility and diagnostic accuracy of a negative breast FNAB result by studying 450 breast aspirates in 413 patients (average age 45 years) with a "negative" or benign cytologic interpretation performed at Massachusetts General Hospital over a 4-year period. Of these patients, 121 (29%) underwent subsequent biopsy and 17 (4%) were found to have malignancy (3% of total negative FNABs; 14% with histology). None of these 17 patients had a triple negative test. A cohort of 115 patients had documentation of negative physical, radiologic, and cytologic examinations (the triple negative), none of whom were found to have malignancy on histologic or at least 2-year clinical follow-up (negative predictive value [NPV] = 100% with a triple-negative test). Outside of the triple-negative test, the NPV of a negative breast FNAB is reduced with a false-negative rate of 7%. However, in the setting of a triple-negative test, the NPV in our patient population was 100%, reassuring the patient and clinician that clinical follow-up and not surgical intervention was sufficient for proper patient care.
authors.affiliation: Department of Pathology, Grady Memorial Hospital, Emory University Medical School, Atlanta, Georgia, USA.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Lau
authors.forename: Grace T
authors.initials: GT
authors.lastname: McKee
authors.forename: Michele M
authors.initials: MM
authors.lastname: Weir
authors.forename: Rosemary H
authors.initials: RH
authors.lastname: Tambouret
authors.forename: John H
authors.initials: JH
authors.lastname: Eichhorn
authors.forename: Martha B
authors.initials: MB
authors.lastname: Pitman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007755:Laboratories, Hospital; D008404:Massachusetts / Q000453:epidemiology; D008499:Medical Records; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies