Lieu David
Department of Pathology, University of California at Los Angeles, Los Angeles, California, USA.
Diagn Cytopathol. 2009 Apr;37(4):262-9. doi: 10.1002/dc.20984.
Fine-needle aspiration (FNA) of breast masses in the United States has been on the decline for the last decade and has been largely replaced by ultrasound-guided core-needle biopsy (UG-CNB). Some studies show core-needle biopsy (CNB) is superior to FNA in terms of absolute sensitivity, specificity, and inadequate rate. However, the importance of a skilled aspirator, experienced cytopathologist, and immediate cytological evaluation (ICE) in FNA is often not considered. CNB is more expensive, invasive, risky, and painful than FNA. This prospective study examines the value of cytopathologist-performed ultrasound-guided FNA (UG-FNA) with ICE as a screening test for cytopathologist-performed UG-CNB on nonpalpable or difficult-to-palpate solid breast masses visible on ultrasound. One hundred twenty consecutive nonpalpable or difficult-to-palpate presumably solid breast masses in 109 female patients from January2, 2008 to June 30, 2008 underwent cytopathologist-performed UG-FNA with ICE. Twenty cases were converted to cytopathologist-performed UG-CNB because ICE was inadequate, hypocellular, atypical, suspicious, or malignant. Patients with clearly benign cytology did not undergo UG-CNB. UG-FNA with ICE reduced the percentage of patients undergoing UG-CNB by 87%. A new role for cytopathologist-performed UG-FNA of nonpalpable breast masses has been identified.
在美国，乳腺肿块的细针穿刺活检（FNA）在过去十年中呈下降趋势，并且在很大程度上已被超声引导下的粗针活检（UG-CNB）所取代。一些研究表明，粗针活检（CNB）在绝对敏感性、特异性和取材不足率方面优于FNA。然而，FNA中熟练的穿刺者、经验丰富的细胞病理学家以及即时细胞学评估（ICE）的重要性常常未被考虑。CNB比FNA更昂贵、更具侵入性、风险更高且更痛苦。这项前瞻性研究探讨了由细胞病理学家进行的超声引导下FNA（UG-FNA）并结合ICE作为对超声可见的不可触及或难以触及的实性乳腺肿块进行细胞病理学家操作的UG-CNB筛查试验的价值。在2008年1月2日至2008年6月30日期间，对109名女性患者连续的120个不可触及或难以触及的疑似实性乳腺肿块进行了由细胞病理学家操作的UG-FNA并结合ICE。由于ICE结果不满意、细胞量少、非典型、可疑或恶性，20例患者转为细胞病理学家操作的UG-CNB。细胞学结果明确为良性的患者未接受UG-CNB。UG-FNA结合ICE使接受UG-CNB的患者比例降低了87%。已确定了细胞病理学家对不可触及乳腺肿块进行UG-FNA的新作用。
