Needle Evaluation of Breast Mass over Outright Open Excision-Biopsy

Needle Evaluation of Breast Mass over Outright Open Excision-Biopsy

by Reynaldo O Joson on Wednesday, January 25, 2012 at 11:55pm

This was a Medical Anecdotal Report (MAR) that I wrote in 2004.   Writing MAR has been part of the educational activity of the residents in the Department of Surgery of Ospital ng Maynila Medical Center since 2004 when I was the Chairman. It aims to develop holistic, professional, and compassionate surgeons among the resident-trainees.


For details on MAR, visit:!/pages/Medical-Anecdotal-Reports/285148858182710?sk=wall



I retrieved this MAR to show the usefulness of needle evaluation as a strategy to avoid unnecessary breast operations.



Indexing Title:

RJOSON’s Medical Anecdotal Report [04-2]


MAR Title:

Needle Evaluation of Breast Mass over Outright Open Excision-Biopsy


Date of Medical Observation: March 30, 2004



A 40-year-old female came to my clinic for second opinion on her health problem of breast mass.


On palpation, she had a 3-cm breast lump on her left breast, well-defined, movable, without any associated ipsilateral axillary lymph node.


My primary diagnosis was benign (60%) and my secondary diagnosis was malignant (40%).


I recommended needle evaluation to which she agreed. Through the needle (G-19, 1.5 inch) attached to a 20-cc syringe, I aspirated 15 cc of brown fluid.  After the aspiration, the mass completely disappeared.  Thus, my post-aspiration diagnosis was Macrocyst, Left Breast with 99% certainty.


After the procedure, the patient divulged to me that a surgeon in another private hospital was recommending outright operation for which she was asked to prepare PhP 30,000.


With what I did, I saved her from an unnecessary operation, expenses of PhP 30,000, pain, and scar.


She was so happy that she gave me pizza on top of my professional fee and she promised she will refer patients to me.



Insights (Discovery, Stimulus, REINFORCEMENT):


A needle evaluation can give an instant diagnosis at the clinic.  It can save unnecessary operation, expenses, pain, and scar.


It is alright that as surgeon you receive less in terms of professional fee when you do needle evaluation compared to when you do an outright open excision-biopsy.   You are doing the patient a great humanitarian service.  You will be rewarded in the future with more patients and in other ways.  You will be known as a surgeon who is not knife-happy.

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