Bukhari Mulazim Hussain, Akhtar Zahid Mahmood
Department of Pathology, King Edward Medical University, Lahore, Pakistan.
Diagn Cytopathol. 2009 Jun;37(6):416-24. doi: 10.1002/dc.21000.
This study was conducted to confirm which of these modalities [mammography (MG), fine-needle aspiration cytology (FNAC), core-needle biopsy (CNB), or intraoperative touch imprint cytology (IOTIC)] is useful to detect breast cancer and to compare the accuracy of these modalities for the diagnostic setting. One hundred seventy-five, 85, 78, and 25 patients were selected who underwent FNAC, MG, IOTIC, and CNB, respectively. Histopathology was used as a gold standard for comparison of the results of all diagnostic modalities. Twenty-five patients with combinations of three preoperative tests (MG, FNAC, CNB) showed 100% accurate results when compared with histopathology, while the overall accuracy for MG, FNAC, and CNB was 91.7%, 91.5%, and 96%, respectively. Both touch and scrape imprints' sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy were 100% for class V and class II smears, while sensitivity, accuracy, and NPV were 87, 95, and 83% for IOTIC and 94%, 96%, and 89% for IOSC for class III and IV smears. On comparison of the results of all these procedures, the difference was nonspecific (P = 0.2, 0.3, 0.5, 0.55, and 0.6 for MG, FNAC, IOTI, IOSC, and CNB, respectively). Combinations of preoperative tests (MG, FNAC, CNB) were more accurate, reliable, and acceptable when compared with individual diagnostic procedure, but these have their own technical limitations. The accuracy of CNB was much higher than that of MG and FNAC. IOTP and IOSC are simple and cost effective diagnostic tests with better accuracy that can be used as an alternate to frozen section in diagnostic settings and margin assessments.
本研究旨在确定这些检查方式[乳腺钼靶摄影（MG）、细针穿刺细胞学检查（FNAC）、粗针活检（CNB）或术中触摸印片细胞学检查（IOTIC）]中哪一种对乳腺癌检测有用，并比较这些检查方式在诊断方面的准确性。分别选取了175例、85例、78例和25例接受FNAC、MG、IOTIC和CNB检查的患者。组织病理学被用作比较所有诊断检查方式结果的金标准。25例接受三种术前检查（MG、FNAC、CNB）联合检查的患者与组织病理学结果相比，显示出100%的准确结果，而MG、FNAC和CNB的总体准确率分别为91.7%、91.5%和96%。对于V级和II级涂片，触摸和刮片印片的敏感性、特异性、阳性预测值、阴性预测值（NPV）和准确率均为100%，而对于III级和IV级涂片，IOTIC的敏感性、准确率和NPV分别为87%、95%和83%，IOSC的分别为94%、96%和89%。比较所有这些检查程序的结果，差异无统计学意义（MG、FNAC、IOTI、IOSC和CNB的P值分别为0.2、0.3、0.5、0.55和0.6）。与单独的诊断程序相比，术前检查（MG、FNAC、CNB）联合检查更准确、可靠且可接受，但这些检查方式有其自身的技术局限性。CNB的准确率远高于MG和FNAC。IOTP和IOSC是简单且经济有效的诊断检查，具有较好的准确性，可在诊断和切缘评估中替代冰冻切片使用。
