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October 1996

Invited Commentary

Author Affiliations

San Francisco, Calif

Arch Surg. 1996;131(10):1098. doi:10.1001/archsurg.1996.01430220092021

The article by Hatada and colleagues shows that ultrasound guidance improved the accuracy of FNAB in lesions smaller than 2 cm. The focus was on identifying cancerous tumors preoperatively. All benign lesions were excised, which is reasonable given the sensitivity of FNAB in this and other reports. Cancer diagnoses were confirmed by frozen section or open biopsy, which also makes sense given the 2 false-positive diagnoses.

This practice, however, severely limits the usefulness and cost-effectiveness of FNAB. Sensitivity and, to a lesser degree, specificity of FNAB vary greatly in published reports; however, there are methods of implementing the technique of FNAB so that it is comparable with open biopsy. Casey et al1 and Layfield et al,2,3 among others, have achieved sensitivity rates of about 98% by combining FNAB with mammography results and clinical presentation (triple test4). The factors improving overall accuracy are (1) proper training in needle