Engvad Birte, Laenkholm Anne-Vibeke, Schwartz Walter, Bak Martin
Afdeling for Klinisk Patologi, Odense Universitetshospital, DK-5000 Odense C.
Ugeskr Laeger. 2009 Aug 17;171(34):2379-82.
In the year 2000 a quality assurance programme for the preoperative breast diagnostics was introduced in Denmark. The programme was based on the "European guidelines for quality assurance in breast cancer screening and diagnosis" where - among other measures - five cytological diagnostic classes were introduced. The aim of this study was to evaluate the quality assurance programme in a screening population to determine whether fine needle aspiration cytology (FNAC) as first choice remains a useful tool in the preoperative diagnostics, or if needle core biopsy should be the first-choice treatment.
767 women had FNAC performed from a total of 783 lesions at the Mammography Clinic, University Hospital Odense. All FNACs were compared with the final histology diagnosis. Nine statistical parameters were calculated according to the European guidelines.
A total of 66% of the 783 FNACs had a malignant cytology diagnosis, which in 99% of the cases turned out to be the correct diagnosis. Four lesions were false positives all of which represented benign proliferative breast diseases. The surgical procedures in these cases were either excisional biopsy or lumpectomy. The values of eight of the nine mutually dependent statistical parameters of quality scored within the recommended threshold values. Specificity was the only parameter that fell outside the recommended threshold values.
Although specificity in our study is lower than recommended, we find that the use of FNAC as first-choice in triple diagnostics is a useful tool.
2000年，丹麦引入了一项针对术前乳腺诊断的质量保证计划。该计划基于“欧洲乳腺癌筛查与诊断质量保证指南”，其中除其他措施外，引入了五个细胞学诊断类别。本研究的目的是评估筛查人群中的质量保证计划，以确定作为首选的细针穿刺细胞学检查（FNAC）在术前诊断中是否仍然是一种有用的工具，或者针芯活检是否应作为首选治疗方法。
在欧登塞大学医院乳腺摄影诊所，对783个病灶中的767名女性进行了FNAC检查。所有FNAC检查结果均与最终组织学诊断进行比较。根据欧洲指南计算了九个统计参数。
783例FNAC检查中，共有66%的病例细胞学诊断为恶性，其中99%的病例最终被证明诊断正确。有4个病灶为假阳性，均为良性乳腺增生性疾病。这些病例的手术方式为切除活检或肿块切除术。九个相互依赖的质量统计参数中有八个的值在推荐阈值范围内。特异性是唯一超出推荐阈值的参数。
尽管我们研究中的特异性低于推荐值，但我们发现，在三联诊断中使用FNAC作为首选是一种有用的工具。
