Pijnappel R M, van den Donk M, Holland R, Mali W P Th M, Peterse J L, Hendriks J H C L, Peeters P H M
Department of Radiology, Martini Hospital, Locatie van Swieten, PO Box 30033, 9700 RM Groningen, The Netherlands.
Br J Cancer. 2004 Feb 9;90(3):595-600. doi: 10.1038/sj.bjc.6601559.
To find out whether ultrasound-guided fine-needle aspiration (FNA) and ultrasound and stereotactic-guided large core needle biopsy (LCNB) are reliable alternatives to needle-localised open breast biopsy (NLBB) in daily practice, we performed a retrospective study and evaluated the validity of these methods. In all, 718 women with 749 nonpalpable breast lesions from three Dutch Hospitals were included, and the validity of the various methods for diagnosis was assessed. This was carried out according to a method described by Burbank and Parker for evaluating the quality of an image-guided breast intervention. We compared our results with the outcome of the COBRA study. Overall, all diagnostic strategies (NLBB, FNA, LCNB ultrasound and stereotactic guided) show comparable agreement rates. However, the miss rates differ: 2% for NLBB, 3% for COBRA (LCNB in study setting), 5% for FNA and 8-12% for LCNB in practice. Fine-needle aspiration was nonconclusive in 29%, and shows an overestimation for DCIS in 9%. The DCIS underestimate rate in NLBB was 8%. For the assessment of lesions consisting of microcalcifications only and to exclude malignancy in all other lesions, a 14-gauge needle should be used. Ultrasound-guided intervention can be performed in a large percentage of nonpalpable lesions. Lesions consisting only of microcalcifications on mammography need special attention.
为了弄清楚在日常实践中，超声引导下细针穿刺抽吸活检（FNA）以及超声和立体定向引导下粗针活检（LCNB）是否是针定位开放性乳腺活检（NLBB）的可靠替代方法，我们进行了一项回顾性研究并评估了这些方法的有效性。总共纳入了来自荷兰三家医院的718名患有749处不可触及乳腺病变的女性，并评估了各种诊断方法的有效性。这是根据Burbank和Parker描述的一种用于评估影像引导下乳腺介入质量的方法进行的。我们将我们的结果与COBRA研究的结果进行了比较。总体而言，所有诊断策略（NLBB、FNA、LCNB超声和立体定向引导）显示出相当的符合率。然而，漏诊率有所不同：NLBB为2%，COBRA（研究环境中的LCNB）为3%，FNA为5%，实际中LCNB为8 - 12%。细针穿刺抽吸活检在29%的病例中无法得出结论，并且在9%的病例中对导管原位癌（DCIS）存在高估。NLBB中DCIS的低估率为8%。对于仅由微钙化组成的病变的评估以及排除所有其他病变中的恶性肿瘤，应使用14号针。超声引导下的介入可在很大比例的不可触及病变中进行。乳腺钼靶上仅由微钙化组成的病变需要特别关注。
