Breast cancer: early diagnosis of precursor lesions and clinically inapparent carcinoma by fine needle aspiration.

Breast cancer death rate has remained stable at 26 per 100,000 for over 50 years. This control failure is due in large part to difficulty in early diagnosis. Combined clinical evaluation, mammography and fine needle aspiration (FNA) offer the best opportunity for early diagnosis. Non-directed FNA is a useful adjunctive technique and three illustrative cases are presented. Cancer evolves from proliferative epithelial disease of ducts and lobules. Atypical duct hyperplasia in association with family history is a pertinent marker for development of cancer. Identification of hyperplastic lesions traditionally occurs after surgical biopsy and histopathologic review. FNA demonstrates patterns of both duct hyperplasia and atypical duct hyperplasia. Ploidy studies of such smears offer the possibility of selecting precancerous lesions for extirpation. A combination of directed and undirected punctures and ploidy studies may yield early diagnosis of precancerous lesions.