Barra Alexandre de Almeida, Gobbi Helenice, de L Rezende César Alencar, Gouvêa Agostinho Pinto, de Lucena Clécio Enio Murta, Reis João Henrique Pena, Costa e Silva Soraya Zhouri
Department of Gynecologic, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Diagn Cytopathol. 2008 Jan;36(1):26-31. doi: 10.1002/dc.20748.
The purpose of the study was to compare the accuracy of FNAC, CNB, and combined biopsy according to tumor size of suspicious breast lesions. FNAC and CNB were performed in 264 patients with suspicious breast lesions from August, 1997 to August, 2002. The procedures were guided by ultrasound and performed in the same session by the same operator. The lesions were divided in four groups according to the tumor size in the histopathology report: lesions smaller than 1 cm, between 1 and 2 cm, between 2 and 5 cm, and lesions greater than 5 cm. The final surgical histopatology results identified 222 (84%) malignant cases and benign lesions summed 42 (16%). For lesions smaller than 1 cm, FNAC, CNB, and combined biopsy were equivalent for all parameters. For lesions between 1 and 2 cm, FNAC and CNB were equivalent. Combined biopsy showed higher absolute sensitivity (P = 0.007) and lower inadequate rate (P = 0.03) when compared to FNAC. However, when combined biopsy and CNB were compared, no difference were found. For lesions between 2 and 5 cm, CNB showed higher absolute sensitivity (P < 0.001) and lower inadequate rate (P < 0.007) when compared to FNAC. Combined biopsy showed higher sensitivity compared to FNAC and CNB alone (P < 0.05) in this group. For lesions greater than 5 cm, FNAC and CNB were equivalent for all parameters. Combined biopsy only showed higher absolute sensitivity (P = 0.04) when compared with FNAC alone. The combination of FNAC and CNB can improve the diagnosis of suspicious breast lesions higher than 1 cm. However, for lesions smaller than 1 cm, our results showed no difference between FNAC, CNB, and combined biopsy, for these lesions any modality has technical limitations.
本研究的目的是根据可疑乳腺病变的肿瘤大小比较细针穿刺抽吸活检（FNAC）、粗针穿刺活检（CNB）及联合活检的准确性。1997年8月至2002年8月期间，对264例可疑乳腺病变患者进行了FNAC和CNB检查。操作在超声引导下由同一名操作人员在同一时间段内完成。根据组织病理学报告中的肿瘤大小，将病变分为四组：小于1cm的病变、1至2cm之间的病变、2至5cm之间的病变以及大于5cm的病变。最终手术组织病理学结果显示，恶性病例有222例（84%），良性病变共计42例（16%）。对于小于1cm的病变，FNAC、CNB及联合活检在所有参数方面相当。对于1至2cm之间的病变，FNAC和CNB相当。与FNAC相比，联合活检显示出更高的绝对敏感性（P = 0.007）和更低的取材不足率（P = 0.03）。然而，联合活检与CNB相比，未发现差异。对于2至5cm之间的病变，与FNAC相比，CNB显示出更高的绝对敏感性（P < 0.001）和更低的取材不足率（P < 0.007）。在该组中，联合活检与单独的FNAC和CNB相比，显示出更高的敏感性（P < 0.05）。对于大于5cm的病变，FNAC和CNB在所有参数方面相当。联合活检仅与单独的FNAC相比显示出更高的绝对敏感性（P = 0.04）。FNAC和CNB联合应用可提高对大于1cm的可疑乳腺病变的诊断。然而，对于小于1cm的病变，我们的结果显示FNAC、CNB及联合活检之间无差异，对于这些病变，任何方式都存在技术局限性。
