Boerner S, Fornage B D, Singletary E, Sneige N
Department of Anatomic Pathology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Cancer. 1999 Feb 25;87(1):19-24. doi: 10.1002/(sici)1097-0142(19990225)87:1<19::aid-cncr4>3.0.co;2-k.
A probabilistic approach to the classification of fine-needle aspirates (FNAs) of the breast recently was recommended and received endorsement from the National Cancer Institute (NCI). In this system, FNAs are classified as benign, indeterminate/atypical, suspicious/probably malignant, and malignant, but to the authors' knowledge the use of these diagnostic categories has not been evaluated on a large scale. Furthermore, this classification scheme has not been applied to FNAs of nonpalpable lesions of the breast obtained under imaging guidance. Thus, the current study focused on whether the diagnostic categories could be applied usefully to ultrasound-guided FNAs (US-FNAs) of nonpalpable breast lesions.
Between 1988-1996, 1885 US-FNAs were performed on 1639 patients. The original FNA diagnoses were reclassified into the NCI-supported recommendations for diagnostic categories of breast FNAs. The cytologic findings were correlated with the tissue specimens, which were available in 851 cases, or with clinical follow-up of a minimum of 2 years in 127 of the 274 patients with benign solid lesions.
The 1885 cases were categorized as follows: 1057 (56.1%) as benign, 86 (4.6%) as atypical, 79 (4.2%) as probably malignant, 502 (26.6%) as malignant, and 161 (8.5%) as unsatisfactory (defined as < 6 epithelial cell groups on all slides). The benign US-FNAs included 480 (45.4%) cysts and 577 (54.6%) solid lesions. Combined clinical and surgical follow-up showed that the frequency of malignancy was 3.7% in US-FNAs classified as benign, 52.9% in those designated as atypical, 75.8% in those designated as suspicious, and 98.9% in those classified as malignant. Based on combined histologic and clinical follow-up, a sensitivity of 97.1% and specificity of 99.1% were found for US-FNAs when definitive benign and malignant diagnoses were considered. A false-negative rate of 3.7% was attributed to sampling error. A false-positive rate of 0.68% was secondary to interpretative error of proliferative lesions.
Application of the NCI-supported diagnostic categories to US-FNA of nonpalpable breast lesions is useful in stratifying aspirates based on the likelihood of underlying malignancy. The subcategories of US-FNAs diagnosed as atypical have similar probabilities of malignancy; this justifies their being grouped as a single category wherein tissue biopsy would be required to exclude carcinoma. Benign and inadequate FNA diagnoses must be correlated with the clinical and imaging findings and in noncorrelative cases the patient should undergo biopsy. US-FNA is a sensitive and specific means with which to diagnose nonpalpable breast lesions.
最近推荐了一种对乳腺细针穿刺抽吸物（FNA）进行分类的概率方法，并得到了美国国立癌症研究所（NCI）的认可。在该系统中，FNA被分类为良性、不确定/非典型、可疑/可能恶性和恶性，但据作者所知，这些诊断类别尚未在大规模研究中进行评估。此外，该分类方案尚未应用于在影像引导下获取的乳腺不可触及病变的FNA。因此，本研究聚焦于这些诊断类别是否能有效地应用于乳腺不可触及病变的超声引导下FNA（US-FNA）。
1988年至1996年间，对1639例患者进行了1885次US-FNA。将最初的FNA诊断重新分类为NCI支持的乳腺FNA诊断类别建议。细胞学结果与851例可获得的组织标本相关，或与274例良性实性病变患者中127例至少2年的临床随访结果相关。
1885例病例分类如下：1057例（56.1%）为良性，86例（4.6%）为非典型，79例（4.2%）为可能恶性，502例（26.6%）为恶性，161例（8.5%）为不满意（定义为所有玻片上上皮细胞团<6个）。良性US-FNA包括480例（45.4%）囊肿和577例（54.6%）实性病变。综合临床和手术随访显示，分类为良性的US-FNA中恶性频率为3.7%，非典型的为52.9%，可疑的为75.8%，恶性的为98.9%。基于组织学和临床联合随访，当考虑明确的良性和恶性诊断时，US-FNA的敏感性为97.1%，特异性为99.1%。假阴性率3.7%归因于采样误差。假阳性率0.68%继发于增殖性病变的解释性误差。
将NCI支持的诊断类别应用于乳腺不可触及病变的US-FNA，有助于根据潜在恶性可能性对抽吸物进行分层。诊断为非典型的US-FNA亚类具有相似的恶性概率；这证明将它们归为单一类别是合理的，在该类别中需要进行组织活检以排除癌。良性和不充分的FNA诊断必须与临床和影像学结果相关，在不相关的情况下患者应接受活检。US-FNA是诊断乳腺不可触及病变的一种敏感且特异的方法。
