Usami Shin, Moriya Takuya, Kasajima Atsuko, Suzuki Akihiko, Ishida Takanori, Sasano Hironobu, Ohuchi Noriaki
Department of Pathology, Tohoku University Hospital, Aoba-ku, Sendai 980-8574, Japan.
Breast Cancer. 2005;12(4):272-8. doi: 10.2325/jbcs.12.272.
Recently, the incidence of non-palpable or noninvasive breast cancer has increased. Consequently, criteria for choosing procedures to obtain pathological materials had changed. Fine needle aspiration biopsy cytology (FNA) and core needle biopsy (CNB) are both reliable procedures for detecting breast cancer. However, for non-palpable lesions, the diagnostic accuracy of CNB is higher. The main limits of FNA are the high rate of insufficient sampling and inability to determine invasiveness. CNB is an established alternative to surgical biopsy, and CNB can avoid excess surgical biopsies in a large number of patients. In addition to accurate histological diagnosis, there is interest in obtaining prognostic information from CNB, especially for patients being considered for preoperative (neoadjuvant) therapy. CNB provides useful information about histologic type and grade. However, an unavoidable problem of CNB is underestimation of invasion. On the other hand, there is good concordance in particular for estrogen receptor (ER) and progesterone receptor (PR) between CNB and surgical excision. Several aspects of CNB remains controversial, such as diagnosing papillary lesions by CNB, problems regarding tumor cell displacement after CNB, and management of lobular neoplasia (LN) on CNB.
近年来，不可触及或非侵袭性乳腺癌的发病率有所上升。因此，选择获取病理材料的检查方法的标准也发生了变化。细针穿刺活检细胞学检查（FNA）和粗针穿刺活检（CNB）都是检测乳腺癌的可靠方法。然而，对于不可触及的病变，CNB的诊断准确性更高。FNA的主要局限性在于取材不足率高以及无法确定是否具有侵袭性。CNB是手术活检的一种既定替代方法，CNB可以避免大量患者进行不必要的手术活检。除了准确的组织学诊断外，人们还希望从CNB中获取预后信息，特别是对于考虑进行术前（新辅助）治疗的患者。CNB能提供有关组织学类型和分级的有用信息。然而，CNB不可避免的一个问题是对侵袭性的低估。另一方面，CNB与手术切除标本在雌激素受体（ER）和孕激素受体（PR）方面具有良好的一致性。CNB的几个方面仍存在争议，例如通过CNB诊断乳头状病变、CNB后肿瘤细胞移位的问题以及CNB上小叶瘤变（LN）的处理。
