Utility of punch biopsy for lesions that are hard to aspirate by conventional fine-needle aspiration.

BACKGROUND

Fine-needle aspiration (FNA) is a fast, reliable, and cost-efficient technique for diagnosing palpable masses. However, when the lesion is small, dermal in location, shallow in depth, or fibrotic, the cellular yield by FNA may be limited and thus hinder an accurate diagnosis. The authors examined the value of punch biopsy (PB) in diagnosing such hard-to-aspirate lesions.

METHODS

The authors reviewed 49 PB specimens from 47 patients who presented in their FNA clinic from June 1994 to July 1997.

RESULTS

The lesions were typically described as ill-defined erythematous skin lesions or as papules or small, firm, subcutaneous nodules (average size, 0.7 cm). Patients' previous history included breast carcinoma (in 36 cases), nonmammary carcinoma (in 3 cases), melanoma (in 2 cases), squamous carcinoma of the skin (in 2 cases), cutaneous T-cell lymphoma (in 2 cases), small lymphocytic lymphoma (in 1 case), and no history of malignancy (in 1 case). PB sites included chest wall, breast, extremities, abdominal wall, neck, back, scalp, and forehead. Of the 37 cases in which FNA was performed before PB, 21 aspirates (57%) were nondiagnostic because of scant cellularity, 11 aspirates (31%) were positive (9) or suspicious/atypical (2) for malignancy, and 5 aspirates (14%) were negative for malignancy. Seventeen (81%) of the 21 nondiagnostic aspirates and 10 of the 11 suspicious/atypical aspirates were positive for malignancy on PB specimens. Twelve PBs were done without prior FNA, 8 (67%) were positive for malignancy, and 4 (33%) were negative. In 7 patients, the findings from the PB specimens (new diagnosis of malignancy in 5 cases and recurrence of disease in 2 cases) led to surgical excision of the lesion.

CONCLUSIONS

PB is a valuable adjunct to FNA for diagnosing hard-to-aspirate lesions.