Masood Shahla, Loya Asif, Khalbuss Walid
Department of Pathology, University of Florida, Health Science Center, Jacksonville, Florida, USA.
Diagn Cytopathol. 2003 Jun;28(6):329-34. doi: 10.1002/dc.10251.
Since the 1980s core needle biopsy (CNB) has gained remarkable popularity and in many institutions it has replaced fine-needle aspiration biopsy (FNAB). However, similar to FNAB, limitation remains in the ability of this procedure to reliably diagnose a small, but prognostically significant, number of breast lesions. These include entities such as atypical ductal hyperplasia, fibro-epithelial tumors, radial scar, papillary lesions, and lobular neoplasia. To assess the diagnostic accuracy of CNB vs. FNAB in the same breast lesions, we reviewed our cases of papillary lesions of the breast. In a retrospective study, we identified 36 cases of FNAB and 11 cases of CNB diagnosed as papillary lesions and compared the results with their corresponding surgical specimen. Interpretation ranged from papillary vs. atypical papillary lesions favoring benign vs. malignant tumors, respectively. Occasionally, definitive diagnosis of papillary carcinoma was entertained. Immunohistochemical staining with smooth muscle actin was used to evaluate the presence or absence of a myoepithelial cell layer. FNAB had benign findings in 21 lesions, atypical in 10, and malignant in five. Of the five lesions yielding malignant features, four had invasive carcinoma and one had micropapillary ductal carcinoma in situ (DCIS). Surgery revealed invasive carcinoma in three of the cases interpreted as atypical papillary lesions and invasive cancer and micropapillary DCIS in three of the cases diagnosed as benign lesions. Similar results were obtained with CNB. DCIS was found in one out of six of the cases diagnosed as papilloma. Out of the four cases that were interpreted as atypical papillary lesion, surgery revealed invasive carcinoma in one case and one case had micropapillary DCIS. Diagnosis of malignancy was confirmed by histology in one case interpreted as papillary carcinoma by CNB. This study suggested that both FNAB and CNB share similar diagnostic challenges and a follow-up surgical excision is indicated when diagnosis of a papillary lesion is entertained by both procedures.
自20世纪80年代以来，粗针活检（CNB）已变得非常流行，在许多机构中它已取代了细针穿刺抽吸活检（FNAB）。然而，与FNAB类似，该方法在可靠诊断少量但具有预后意义的乳腺病变方面仍存在局限性。这些病变包括非典型导管增生、纤维上皮性肿瘤、放射状瘢痕、乳头状病变和小叶瘤变等。为了评估CNB与FNAB对同一乳腺病变的诊断准确性，我们回顾了我们的乳腺乳头状病变病例。在一项回顾性研究中，我们确定了36例经FNAB诊断为乳头状病变的病例和11例经CNB诊断为乳头状病变的病例，并将结果与相应的手术标本进行比较。解读范围从乳头状与非典型乳头状病变，分别倾向于良性与恶性肿瘤。偶尔，会考虑对乳头状癌进行明确诊断。使用平滑肌肌动蛋白进行免疫组织化学染色以评估肌上皮细胞层的有无。FNAB在21个病变中发现良性结果，10个为非典型，5个为恶性。在产生恶性特征的5个病变中，4个为浸润性癌，1个为微乳头导管原位癌（DCIS）。手术显示，在被解释为非典型乳头状病变的3例病例中有浸润性癌，在被诊断为良性病变的3例病例中有浸润性癌和微乳头DCIS。CNB也得到了类似的结果。在被诊断为乳头状瘤的6例病例中有1例发现了DCIS。在被解释为非典型乳头状病变的4例病例中，手术显示1例有浸润性癌，1例有微乳头DCIS。在1例经CNB解释为乳头状癌的病例中，组织学证实了恶性诊断。这项研究表明，FNAB和CNB都面临类似的诊断挑战，当两种方法都考虑诊断乳头状病变时，均需进行后续手术切除。
