The future of medicine: "...same-day diagnosis that allows treatment planning to be initiated at the same visit..."

Ann Surg Oncol. 2013 Dec 31. [Epub ahead of print]

Surgeon-Performed Touch Preparation of Breast Core Needle Biopsies May Provide Accurate Same-Day Diagnosis and Expedite Treatment Planning.

Gadgil PV, Korourian S, Malak S, Ochoa D, Lipschitz R, Henry-Tillman R, Suzanne Klimberg V.

Author information

• Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, USA.

Abstract

BACKGROUND:

We aimed to determine the accuracy of surgeon-performed touch-preparation cytology (TPC) of breast core-needle biopsies (CNB) and the ability to use TPC results to initiate treatment planning at the same patient visit.

METHODS:

A single-institution retrospective review of TPC results of ultrasound-guided breast CNB was performed. All TPC slides were prepared by surgeons performing the biopsy and interpreted by the pathologist. TPC results were reported as positive/suspicious, atypical, negative/benign, or deferred; these were compared with final pathology of cores to calculate accuracy. Treatment planning was noted as having taken place if the patient had requisition of advanced imaging, referrals, or surgical planning undertaken during the same visit.

RESULTS:

Four hundred forty-seven CNB specimens with corresponding TPC were evaluated from 434 patient visits, and 203 samples (45.4 %) were malignant on final pathology. When the deferred, atypical, and benign results were considered negative and positive/suspicious results were considered positive, sensitivity and specificity were 83.7 % (77.9-88.5 %) and 98.4 % (95.9-99.6 %), respectively; positive and negative predictive values were 97.7 % (94.2-99.4 %) and 87.9 % (83.4-91.5 %), respectively. In practice, patients with atypical or deferred results were asked to await final pathology. An accurate same-day diagnosis (TPC positive/suspicious) was hence feasible in 83.7 % (170 of 203) of malignant and 79.5 % (194 of 244) of benign cases (TPC negative). Of patients who had a same-day diagnosis of a new malignancy, 77.3 % had treatment planning initiated at the same visit.

CONCLUSIONS:

Surgeon-performed TPC of breast CNB is an accurate method of same-day diagnosis that allows treatment planning to be initiated at the same visit and may serve to expedite patient care.