Lee H C, Ooi P J, Poh W T, Wong C Y
Department of General Surgery, Singapore General Hospital.
Aust N Z J Surg. 2000 Sep;70(9):656-9. doi: 10.1046/j.1440-1622.2000.01920.x.
The purpose of the present study was to assess the impact of inadequate fine-needle aspiration cytology (FNAC) breast specimens on the outcome of patients with a palpable breast lesion.
A retrospective review was carried out of inadequate FNAC specimens from the Department of General Surgery, Singapore General Hospital in 1997.
One hundred and thirty-eight (16.6%) of 831 FNAC specimens were reported inadequate, and these form the study group. Outcome analysis was divided into benign on excision biopsy (n = 38; 29.4%); benign on repeat FNAC or trucut biopsy (n = 6; 4.7%); benign on follow up (n = 46; 35.7%); malignant on histology (n = 11; 8.5%); and lost to follow up (n = 28; 21.7%). The 11 cases with breast cancer were further analysed. The mean time to treatment was 88.3 days for three patients whose tumours were not clinically suspicious of malignancy versus 20 days for six patients who were diagnosed with cancer clinically from the onset. One patient with cancer refused treatment and one absconded from treatment only to return 7 months later.
Breast cancer was present in 8.5% of the inadequate FNAC specimens. When clinical suspicion of malignancy is high, an excision biopsy is advised in patients with inadequate FNAC specimens. If properly managed with triple tests and good clinical judgement, the inadequate FNAC specimens do not delay treatment in patients with breast cancer.
本研究的目的是评估乳腺细针穿刺细胞学检查（FNAC）标本质量欠佳对可触及乳腺病变患者治疗结果的影响。
对新加坡总医院普通外科1997年质量欠佳的FNAC标本进行回顾性研究。
831份FNAC标本中有138份（16.6%）报告为质量欠佳，这些标本构成研究组。结果分析分为切除活检为良性（n = 38；29.4%）；重复FNAC或粗针活检为良性（n = 6；4.7%）；随访为良性（n = 46；35.7%）；组织学检查为恶性（n = 11；8.5%）；失访（n = 28；21.7%）。对11例乳腺癌病例进行了进一步分析。3例肿瘤临床未怀疑为恶性的患者平均治疗时间为88.3天，而6例从一开始临床就诊断为癌症的患者平均治疗时间为20天。1例癌症患者拒绝治疗，1例放弃治疗，7个月后才回来。
质量欠佳的FNAC标本中8.5%存在乳腺癌。当临床高度怀疑为恶性时，建议对FNAC标本质量欠佳的患者进行切除活检。如果通过三联检查和良好的临床判断进行妥善处理，质量欠佳的FNAC标本不会延误乳腺癌患者的治疗。
