Farshid Gelareh, Pieterse Steve
BreastScreen SA, Wayville, South Australia, Australia.
Cancer. 2006 Jun 25;108(3):150-6. doi: 10.1002/cncr.21939.
In multidisciplinary assessment clinics for screen-detected breast lesions, onsite cytopathologists provide immediate results of fine-needle aspiration biopsies (FNABs) and this information is used for patient counseling and treatment planning. Such consultation is not possible for the increasing proportion of lesions that are being assessed by core biopsy. If core imprint cytology (CIC) of breast cores can be shown to be reliable in a significant proportion of screen-detected lesions, this technique may be of clinical value in such clinics.
In the setting of a large, accredited, population-based breast cancer screening program, prospective results of CIC were gathered on 567 lesions and correlated with the results of core biopsy to determine the performance indicators for CIC.
The positive predictive value of a diagnosis of malignancy on CIC was 98.2% and the negative predictive value was 77.8%. The absolute sensitivity was 42.2%, complete sensitivity (inclusive of suspicious and atypical results) was 86.4%, absolute specificity was 56.3%, and total specificity (inclusive of acellular imprints) was 83.7%. The 2 false-positive imprints had atypical ductal hyperplasia on core histology but were found to be ductal carcinoma in situ (DCIS) on excision. False-negative imprints are a greater challenge, with 13.6% of malignant lesions producing benign-appearing or acellular imprints. Low-grade DCIS, lobular, and special type cancers account for most such lesions. The results of the current study also demonstrated significant variations in the accuracy of CIC in microcalcifications versus parenchymal lesions. In particular, the results of acellular imprints are analogous to benign CIC findings for microcalcifications but not in parenchymal lesions.
The current study may be the largest prospective series on CIC to date, and the only direct comparison of its results for microcalcifications versus parenchymal lesions. Breast CIC is a reliable predictor of core histology. The information this study provides can be used to clinical advantage.
在筛查发现的乳腺病变多学科评估诊所中，现场细胞病理学家会提供细针穿刺活检（FNAB）的即时结果，该信息用于患者咨询和治疗规划。对于越来越多通过粗针活检评估的病变，这种会诊是不可能的。如果乳腺粗针印片细胞学检查（CIC）在很大比例的筛查发现的病变中被证明是可靠的，那么这项技术在这类诊所中可能具有临床价值。
在一个大型的、经认可的、基于人群的乳腺癌筛查项目中，收集了567个病变的CIC前瞻性结果，并与粗针活检结果进行关联，以确定CIC的性能指标。
CIC诊断恶性肿瘤的阳性预测值为98.2%，阴性预测值为77.8%。绝对敏感性为42.2%，完全敏感性（包括可疑和非典型结果）为86.4%，绝对特异性为56.3%，总特异性（包括无细胞印片）为83.7%。2例假阳性印片在粗针组织学上为非典型导管增生，但在切除时被发现为原位导管癌（DCIS）。假阴性印片是一个更大的挑战，13.6%的恶性病变产生良性外观或无细胞印片。低级别DCIS、小叶癌和特殊类型癌症占大多数此类病变。本研究结果还表明，CIC在微钙化与实质病变中的准确性存在显著差异。特别是，无细胞印片的结果类似于微钙化的良性CIC结果，但在实质病变中并非如此。
本研究可能是迄今为止关于CIC的最大规模前瞻性系列研究，也是其在微钙化与实质病变结果方面的唯一直接比较。乳腺CIC是粗针组织学的可靠预测指标。本研究提供的信息可用于临床优势。
