Maygarden S J, McCall J B, Frable W J
Department of Pathology, Medical College of Virginia, Virginia Commonwealth University, Richmond.
Acta Cytol. 1991 Nov-Dec;35(6):687-94.
Fine needle aspiration (FNA) biopsies of 1,598 breast masses were performed between 1983 and 1989, and of them, 48 were from women aged 30 and under for whom a cytologic diagnosis was made by FNA and histologic follow-up was available. In 37 (77%) of the cases, both the cytologic and histologic diagnoses were benign. Fibroadenoma (20/37) and fibrocystic changes (14/37) were the most common benign lesions aspirated. Eight (17%) FNAs showed cytologic atypia. Four of these atypical lesions proved to be benign (two fibroadenomas, two fibrocystic changes). Epithelial proliferation in fibroadenomas and fibrocystic changes and cellular stroma in a fibroadenoma mimicking phylloides tumor were the causes of atypia in these biopsies. Four of the eight atypical lesions were shown to be carcinoma at biopsy (three infiltrating duct, one atypical medullary). Low cellularity, epithelial cohesiveness mimicking a fibroadenoma and background lactational changes in a pregnant patient were the causes of the atypical, rather than unequivocally malignant, diagnoses in these cases. In three patients (6%), a diagnosis of carcinoma was made by FNA and confirmed histologically (all were infiltrating duct carcinoma). Although most breast masses in women aged 30 and under are benign, cytologic atypia in a breast fine needle aspirate in this age group warrants a surgical biopsy. Clinical follow-up alone may be appropriate for young women with clinically nonsuspicious breast masses without cytologic atypia.
1983年至1989年间，对1598例乳腺肿块进行了细针穿刺（FNA）活检，其中48例来自30岁及以下的女性，这些患者通过FNA进行了细胞学诊断，并获得了组织学随访结果。在37例（77%）病例中，细胞学和组织学诊断均为良性。纤维腺瘤（20/37）和纤维囊性变（14/37）是最常见的穿刺良性病变。8例（17%）FNA显示细胞学非典型性。其中4例非典型病变被证实为良性（2例纤维腺瘤，2例纤维囊性变）。这些活检中非典型性的原因是纤维腺瘤和纤维囊性变中的上皮增生以及1例类似叶状肿瘤的纤维腺瘤中的细胞性间质。8例非典型病变中有4例在活检时被证实为癌（3例浸润性导管癌，1例非典型髓样癌）。细胞含量低、类似纤维腺瘤的上皮黏附性以及1例孕妇患者的背景哺乳期改变是这些病例中诊断为非典型而非明确恶性的原因。在3例患者（6%）中，FNA诊断为癌并经组织学证实（均为浸润性导管癌）。尽管30岁及以下女性的大多数乳腺肿块是良性的，但该年龄组乳腺细针穿刺中的细胞学非典型性仍需进行手术活检。对于临床无可疑表现且无细胞学非典型性的年轻女性乳腺肿块，仅进行临床随访可能就足够了。
