Ibrahim A E, Bateman A C, Theaker J M, Low J L, Addis B, Tidbury P, Rubin C, Briley M, Royle G T
Departments of Histopathology and Cytopathology, Southampton University Hospitals NHS Trust, Tremona Road, Southampton, SO16 6YO, UK.
J Clin Pathol. 2001 Feb;54(2):121-5. doi: 10.1136/jcp.54.2.121.
To investigate the role of needle core biopsy (NCB) in the preoperative assessment of impalpable breast lesions, mainly derived from the NHS Breast Screening Programme (NHSBSP) and to assess our own modifications to a suggested system for the classification of breast NCBs.
The NCB, fine needle aspiration cytology (FNAC), and radiology scores from 298 women with non-palpable breast lesions presenting between January 1997 and December 1998, together with the open biopsy results (where available) were collated and analysed.
The mean follow up period was 15.8 months (range, 5-28). The 298 NCB specimens were categorised as follows: unsatisfactory/non-representative (B1; n = 61; 20.5%), benign but uncertain whether representative (B2r; n = 52; 17.4%), benign (B2; n = 103; 34.6%), lesions possibly associated with malignancy but essentially benign (B3a; n = 9; 3.0%), atypical epithelial proliferations (B3b; n = 10; 3.4%), suspicious of malignancy (B4; n = 7; 2.3%), and malignant (B5; n = 56; 18.7%). Excision biopsy was performed in 43 cases within the B1 (n = 19), B2r (n = 8), B2 (n = 8), and the B3a (n = 8; data unavailable in one case) categories, revealing malignancy in 18 (42.8%) cases and in 65 cases within the B3b, B4, and B5 categories, revealing malignancy in 64 cases (98.5%). The sensitivity of NCB for malignancy was 87.7%, with a specificity and positive predictive value of 99.3% and 98.5%, respectively. FNAC had an inadequacy rate of 58.7%, a complete sensitivity of 34.5% and a specificity of 47.6%.
This study confirms the value of NCB in the preoperative assessment of impalpable breast lesions. Two new categories are suggested for the NCB classification; category B2r for benign breast tissue where representativeness is uncertain, and the subdivision of category B3 into B3a for benign lesions potentially associated with malignancy (for example, radial scars and intraduct papillomas) and B3b for more worrisome atypical epithelial proliferations. These will aid the accurate audit of NCB and identify more clearly the intellectual pathway leading to a particular assessment.
探讨粗针活检（NCB）在不可触及乳腺病变术前评估中的作用，这些病变主要来自英国国家医疗服务体系乳腺筛查项目（NHSBSP），并评估我们对乳腺NCB分类建议系统所做的修改。
整理并分析了1997年1月至1998年12月期间298例患有不可触及乳腺病变女性的NCB、细针穿刺细胞学检查（FNAC）及放射学评分，以及开放活检结果（若有）。
平均随访期为15.8个月（范围5 - 28个月）。298份NCB标本分类如下：不满意/无代表性（B1；n = 61；20.5%），良性但代表性不确定（B2r；n = 52；17.4%），良性（B2；n = 103；34.6%），可能与恶性肿瘤相关但本质上为良性的病变（B3a；n = 9；3.0%），非典型上皮增生（B3b；n = 10；3.4%），怀疑为恶性（B4；n = 7；2.3%），以及恶性（B5；n = 56；18.7%）。对B1（n = 19）、B2r（n = 8）、B2（n = 8）和B3a（n = 8；1例数据不可用）类别中的43例进行了切除活检，其中18例（42.8%）发现为恶性；对B3b、B4和B5类别中的65例进行了切除活检，其中64例（98.5%）发现为恶性。NCB对恶性肿瘤的敏感性为87.7%，特异性和阳性预测值分别为99.3%和98.5%。FNAC的不充分率为58.7%，完全敏感性为34.5%，特异性为47.6%。
本研究证实了NCB在不可触及乳腺病变术前评估中的价值。建议对NCB分类增加两个新类别；B2r用于代表性不确定的良性乳腺组织，将B3类别细分为B3a用于可能与恶性肿瘤相关的良性病变（如放射状瘢痕和导管内乳头状瘤）以及B3b用于更令人担忧的非典型上皮增生。这些将有助于对NCB进行准确的审核，并更清楚地确定导致特定评估的思路。
