Ciatto S, Rosselli del Turco M, Bravetti P, Catarzi S
Centro per lo Studio e la Prevenzione Oncologica, Firenze.
Radiol Med. 1991 Jan-Feb;81(1-2):65-8.
The authors report on 791 consecutive cases undergoing stereotaxic cytology for nonpalpable lesions detected at mammography. Histologic diagnosis (malignant = 179, benign = 107) or mammographic follow-up after at least one year (benign = 275) was available in 561 cases. The overall inadequacy rate of stereotaxic cytology was 0.21, and dependent on lesion type (benign = 0.25, malignant = 0.13 p less than 0.001) and on sampling operator experience (range 0.17-0.31, p less than 0.001). Sensitivity (dubious + positive, after exclusion of inadequates) was 0.83 and dependent on histologic type (infiltrating = 0.87, intraductal = 0.68). Specificity (negative/benign, after exclusion of inadequates) was 0.96. Stereotaxic cytology helped in reducing the number of unnecessary benign biopsies and the biopsy ratio was 0.6 benign to 1 malignant biopsy. In cases with moderate suspicion at mammography the radiologist felt reassured by negative cytology and advised mammographic control rather than surgical biopsy. Cytology was determinant in advising surgical biopsy in 9 cancer cases whereas the absence of cytologic positivity contributed to diagnostic delay in 2 cancer cases. Overall, stereotaxic cytology allowed a relevant reduction of unnecessary benign biopsies and should be routinely employed in the diagnostic work-up of nonpalpable lesions detected at mammography.
作者报告了791例因乳腺钼靶检查发现不可触及病变而接受立体定向细胞学检查的连续病例。561例病例有组织学诊断结果（恶性 = 179例，良性 = 107例）或至少随访一年的乳腺钼靶检查结果（良性 = 275例）。立体定向细胞学检查的总体不充分率为0.21，且取决于病变类型（良性 = 0.25，恶性 = 0.13，p<0.001）以及取样操作人员的经验（范围为0.17 - 0.31，p<0.001）。敏感性（排除不充分样本后可疑 + 阳性）为0.83，且取决于组织学类型（浸润性 = 0.87，导管内 = 0.68）。特异性（排除不充分样本后阴性/良性）为0.96。立体定向细胞学检查有助于减少不必要的良性活检数量，活检比例为0.6例良性对1例恶性活检。在乳腺钼靶检查有中度怀疑的病例中，放射科医生因细胞学检查结果为阴性而放心，并建议进行乳腺钼靶复查而非手术活检。细胞学检查在9例癌症病例中对建议手术活检起决定性作用，而在2例癌症病例中缺乏细胞学阳性结果导致诊断延迟。总体而言，立体定向细胞学检查可显著减少不必要的良性活检，应常规用于乳腺钼靶检查发现的不可触及病变的诊断工作。
