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New masses in the head and neck region of previously treated patients with cancer are considered suggestive of potential recurrence. Fine-needle aspiration is an excellent primary tool for evaluating these masses but may show atypical squamous cells that mislead clinicians to pursue aggressive treatment. We describe 3 patients in whom submandibular gland masses developed after radiation therapy for squamous cell carcinoma and for whom subsequent excisional biopsy findings showed benign squamous metaplasia. We review distinguishing clinical and histopathologic features that may allow these lesions to be identified. We also propose a treatment algorithm for this uncommon clinical scenario.

The change toward breast-conserving surgery for cancer has altered the role of the initial biopsy. We retrospectively analyzed two methods, traditional excisional biopsy (n = 47) and lumpectomy (n = 44) to evaluate their usefulness as the initial procedure for breast-conserving surgery. Lumpectomy required more time (mean +/- SEM, 53 +/- 3 minutes) than traditional biopsy (37 +/- 2 minutes). Margins were verified by microscopic examination to be clear in 73% of the patients in the lumpectomy group and in only 17% of patients in the traditional biopsy group. Patients in the lumpectomy group subsequently underwent more axillary dissections than patients in the traditional biopsy group (31% vs 4%, respectively) and fewer modified radical mastectomies (49% vs 71%, respectively). A correlation between extensive intraductal components and positive margins was found in the lumpectomy group. These data suggest that as the initial biopsy method, lumpectomy more often provides adequate margins and may decrease the number of subsequent procedures on the breast for breast-conserving surgery.