Kanhoush Rima, Jorda Merce, Gomez-Fernandez Carmen, Wang Hong, Mirzabeigi Marjan, Ghorab Zeina, Ganjei-Azar Parvin
Department of Pathology, University of Miami/Jackson Memorial Medical Center, Miami, Florida, USA.
Cancer. 2004 Jun 25;102(3):164-7. doi: 10.1002/cncr.20283.
In 1996, the National Cancer Institute (NCI) recommended five categories for the diagnosis of breast aspiration cytology: benign, atypical, suspicious, malignant, and unsatisfactory. The authors evaluated the usefulness of separating inconclusive diagnoses into the aforementioned atypical and suspicious categories. The current study examined the correlation between cytologic and histologic findings made in breast aspiration cytology specimens that were categorized in accordance with these NCI guidelines.
From 1992 to 2000, 7727 breast aspirations were performed at the University of Miami/Jackson Memorial Medical Center (Miami, FL). Aspirates were classified using criteria similar to the NCI recommendations. Four hundred eighty-nine aspirates (6%) were classified as being cytologically 'atypical' or 'suspicious'. Of those, 225 'atypical' aspirates and 162 'suspicious' aspirates had available histologic follow-up data and were included in the study.
Among the 'atypical' aspirates, 118 (52%) yielded malignant findings on histologic evaluation. Infiltrating ductal carcinoma (n = 87; 74%) was the most common malignant diagnosis, followed by infiltrating lobular carcinoma (n = 12; 10%). Among 'suspicious' aspirates, 135 (83%) yielded malignant findings on histologic analysis. The most common benign diagnosis in both 'atypical' and 'suspicious' aspirates was proliferative fibrocystic changes with or without atypia, followed by fibroadenoma.
Most aspirates that yielded suspicious findings on cytologic examination proved to be malignant, as did > 50% of aspirates that yielded atypical findings. Infiltrating lobular carcinoma commonly was underdiagnosed as being atypical on cytologic examination. Benign lesions with atypical or suspicious cytologic diagnoses included certain cases of atypical ductal hyperplasia. The authors concluded that the distinction between the atypical and suspicious categories, as recommended by the NCI, is not warranted. Therefore, they suggest the use of a single term, such as 'equivocal', to describe inconclusive diagnoses on breast fine-needle aspiration cytology.
1996年，美国国立癌症研究所（NCI）推荐了五类乳腺穿刺细胞学诊断：良性、非典型性、可疑、恶性和不满意。作者评估了将不确定诊断分为上述非典型性和可疑类别是否有用。本研究检查了根据这些NCI指南分类的乳腺穿刺细胞学标本中细胞学和组织学检查结果之间的相关性。
1992年至2000年期间，迈阿密大学/杰克逊纪念医学中心（佛罗里达州迈阿密）进行了7727例乳腺穿刺。穿刺物根据与NCI建议相似的标准进行分类。489例穿刺物（6%）在细胞学上被分类为“非典型性”或“可疑”。其中，225例“非典型性”穿刺物和162例“可疑”穿刺物有可用的组织学随访数据并被纳入研究。
在“非典型性”穿刺物中，118例（52%）在组织学评估中得出恶性结果。浸润性导管癌（n = 87；74%）是最常见的恶性诊断，其次是浸润性小叶癌（n = 12；10%）。在“可疑”穿刺物中，135例（83%）在组织学分析中得出恶性结果。“非典型性”和“可疑”穿刺物中最常见的良性诊断是伴有或不伴有非典型性的增生性纤维囊性改变，其次是纤维腺瘤。
大多数在细胞学检查中得出可疑结果的穿刺物被证明是恶性的，超过50%得出非典型性结果的穿刺物也是如此。浸润性小叶癌在细胞学检查中通常被误诊为非典型性。具有非典型性或可疑细胞学诊断的良性病变包括某些非典型导管增生病例。作者得出结论，NCI建议的非典型性和可疑类别之间的区分是没有必要的。因此，他们建议使用一个单一术语，如“模棱两可”，来描述乳腺细针穿刺细胞学的不确定诊断。
