Kwak Jin Young, Kim Eun-Kyung, Park Hai-Lin, Kim Ji-Young, Oh Ki Keun
Department of Diagnostic Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-gu, Seoul 120-752, Korea.
J Ultrasound Med. 2006 Oct;25(10):1255-61. doi: 10.7863/jum.2006.25.10.1255.
The purpose of our study was to evaluate the utility of the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) sonographic final assessment system and palpation-guided fine-needle aspiration (FNA) for evaluation of palpable breast lesions.
Our computerized database identified 160 palpable lesions of the breast in which follow-up palpation-guided FNA, targeted sonography, and pathologic confirmation were performed. We used BI-RADS sonographic data on all lesions. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of malignancy were calculated for sonography and palpation-guided FNA. Two-sample binomial proportion tests were used as the statistical analysis (P<.05).
The FNA results were defined as benign, atypical cells, suspicious for malignancy, malignancy, and insufficiency. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 90.9%, 82.7%, 84.3%, 57.7%, and 97.2%, respectively, on sonography and 75.8% to 90.9%, 82.7% to 98.4%, 84.3% to 94.4%, 57.7% to 92.6%, and 93.9% to 97.2% on FNA. There was no statistically significant difference for sensitivity and negative predictive value between the two examinations.
The diagnostic accuracy of sonography was similar to that of palpation-guided FNA for not missing the malignancy. Clinical application of FNA results can be difficult, especially when the result is insufficiency or atypical cells. Moreover, FNA is invasive and overlaps other procedures. Therefore, we conclude that sonography can replace palpation-guided FNA for diagnosis of palpable lesions of the breast when the BI-RADS sonographic final assessment system is used appropriately.
我们研究的目的是评估美国放射学会的乳腺影像报告和数据系统（BI-RADS）超声最终评估系统以及触诊引导下细针穿刺抽吸活检（FNA）对可触及乳腺病变的评估效用。
我们的计算机数据库识别出160例可触及的乳腺病变，对这些病变均进行了后续的触诊引导下FNA、靶向超声检查以及病理确诊。我们使用了所有病变的BI-RADS超声数据。计算超声检查和触诊引导下FNA对恶性病变的敏感性、特异性、准确性、阳性预测值和阴性预测值。采用双样本二项比例检验进行统计分析（P<0.05）。
FNA结果被定义为良性、非典型细胞、可疑恶性、恶性以及取材不足。超声检查的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为90.9%、82.7%、84.3%、57.7%和97.2%，FNA的相应数值为75.8%至90.9%、82.7%至98.4%、84.3%至94.4%、57.7%至92.6%以及93.9%至97.2%。两项检查在敏感性和阴性预测值方面无统计学显著差异。
在不遗漏恶性病变方面，超声检查的诊断准确性与触诊引导下FNA相似。FNA结果的临床应用可能存在困难，尤其是当结果为取材不足或非典型细胞时。此外，FNA具有侵入性且与其他检查存在重叠。因此，我们得出结论，当恰当使用BI-RADS超声最终评估系统时，超声检查可替代触诊引导下FNA用于诊断可触及的乳腺病变。
