ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298, USA.
Ann Intern Med. 2010 Feb 16;152(4):238-46. doi: 10.7326/0003-4819-152-1-201001050-00190. Epub 2009 Dec 14.
Most women undergoing breast biopsy are found not to have cancer.
To compare the accuracy and harms of different breast biopsy methods in average-risk women suspected of having breast cancer.
Databases, including MEDLINE and EMBASE, searched from 1990 to September 2009.
Studies that compared core-needle biopsy diagnoses with open surgical diagnoses or clinical follow-up.
Data were abstracted by 1 of 3 researchers and verified by the primary investigator.
33 studies of stereotactic automated gun biopsy; 22 studies of stereotactic-guided, vacuum-assisted biopsy; 16 studies of ultrasonography-guided, automated gun biopsy; 7 studies of ultrasonography-guided, vacuum-assisted biopsy; and 5 studies of freehand automated gun biopsy met the inclusion criteria. Low-strength evidence showed that core-needle biopsies conducted under stereotactic guidance with vacuum assistance distinguished between malignant and benign lesions with an accuracy similar to that of open surgical biopsy. Ultrasonography-guided biopsies were also very accurate. The risk for severe complications is lower with core-needle biopsy than with open surgical procedures (<1% vs. 2% to 10%). Moderate-strength evidence showed that women in whom breast cancer was initially diagnosed by core-needle biopsy were more likely than women with cancer initially diagnosed by open surgical biopsy to be treated with a single surgical procedure (random-effects odds ratio, 13.7 [95% CI, 5.5 to 34.6]).
The strength of evidence was rated low for accuracy outcomes because the studies did not report important details required to assess the risk for bias.
Stereotactic- and ultrasonography-guided core-needle biopsy procedures seem to be almost as accurate as open surgical biopsy, with lower complication rates.
Agency for Healthcare Research and Quality.
大多数接受乳房活检的女性并未发现患有癌症。
比较不同的乳房活检方法在疑似患有乳腺癌的一般风险女性中的准确性和危害。
包括 MEDLINE 和 EMBASE 在内的数据库，从 1990 年至 2009 年 9 月进行检索。
比较空心针活检诊断与开放手术诊断或临床随访的研究。
由 3 位研究人员中的 1 位提取数据，并由主要研究者进行验证。
符合纳入标准的有 33 项立体定向自动枪活检研究；22 项立体定向引导、真空辅助活检研究；16 项超声引导、自动枪活检研究；7 项超声引导、真空辅助活检研究；5 项徒手自动枪活检研究。低强度证据表明，在立体定向引导下使用真空辅助进行空心针活检可区分恶性和良性病变，其准确性与开放手术活检相似。超声引导活检也非常准确。空心针活检的严重并发症风险低于开放手术（<1%对 2%至 10%）。中度强度证据表明，最初通过空心针活检诊断为乳腺癌的女性比最初通过开放手术活检诊断为癌症的女性更有可能通过单一手术治疗（随机效应比值，13.7[95%CI，5.5 至 34.6]）。
由于研究未报告评估偏倚风险所需的重要细节，因此准确性结果的证据强度被评为低。
立体定向和超声引导空心针活检程序似乎与开放手术活检一样准确，且并发症发生率较低。
医疗保健研究与质量局。
