Lieske B, Ravichandran D, Wright D
Bedfordshire and Hertfordshire Breast Screening Unit and Luton & Dunstable Breast Unit, Luton & Dunstable Hospital, Lewsey Road, Luton, Bedfordshire LU4 0DZ, UK.
Br J Cancer. 2006 Jul 3;95(1):62-6. doi: 10.1038/sj.bjc.6603211. Epub 2006 Jun 6.
Core biopsy (CB) has now largely replaced fine-needle aspiration cytology (FNAC) in the preoperative assessment of breast cancer in the UK. We studied the contribution of FNAC and CB in the preoperative diagnosis of screen-detected breast carcinoma. Data were prospectively collected on 150 840 women who underwent breast screening over a 4-year period from 1999 to 2003. Data on women who had both FNAC and CB taken from the same lesion preoperatively and in whom surgical excision of the lesion subsequently confirmed malignancy was analysed. In 763 cancers, FNAC was inadequate (C1) in 8% and benign (C2) in 10%. Most of these cases presented with microcalcification (25% were C1 or C2). Core biopsy was not representative (B1) or benign (B2) in 7%. The absolute and complete sensitivities were 65 and 82% for FNAC and 80 and 93% for CB in the diagnosis of cancer. Core biopsy was abnormal (B3 or above) in 86% of the cancers missed by FNAC and FNAC was abnormal (C3 or above) in 65% of those missed by CB. Core biopsy is better than FNAC at preoperative diagnosis of screen-detected breast cancer as it missed fewer cancers. However, combining FNAC resulted in a better preoperative diagnosis rate.
在英国，粗针活检（CB）目前在乳腺癌术前评估中已在很大程度上取代了细针穿刺细胞学检查（FNAC）。我们研究了FNAC和CB在筛查发现的乳腺癌术前诊断中的作用。前瞻性收集了1999年至2003年4年间接受乳腺筛查的150840名女性的数据。对术前从同一病变部位同时进行FNAC和CB检查，且随后病变手术切除证实为恶性肿瘤的女性数据进行了分析。在763例癌症中，FNAC诊断不充分（C1）的占8%，诊断为良性（C2）的占10%。这些病例大多表现为微钙化（25%为C1或C2）。CB不具有代表性（B1）或诊断为良性（B2）的占7%。在癌症诊断中，FNAC的绝对敏感性和完全敏感性分别为65%和82%，CB分别为80%和93%。在FNAC漏诊的癌症中，86%的病例CB结果异常（B3及以上）；在CB漏诊的病例中，65%的病例FNAC结果异常（C3及以上）。在筛查发现的乳腺癌术前诊断中，CB比FNAC更好，因为其漏诊的癌症更少。然而，联合使用FNAC可提高术前诊断率。
