Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Ngan Shing Street, Shatin, Hong Kong, People's Republic of China.
Breast Cancer Res Treat. 2012 Apr;132(3):917-23. doi: 10.1007/s10549-011-1639-3. Epub 2011 Jun 23.
Needle biopsy is now the initial investigation of choice for the pre-operative diagnosis of breast lesions. This includes core needle biopsy (CNB) and vacuum-assisted biopsy (VAB) with or without radiologic assistance. The performance indices of both of these biopsy techniques were evaluated. In a large cohort of patients with breast lesions including 464 cases (285 CNB and 179 VAB), with confirmed outcomes, the diagnostic accuracy was compared using parameters including quantitation of the sampling based on the total number of cores taken, cores containing breast parenchyma, and cores with lesion; and non-epithelial changes including necrosis and calcification. CNB showed a 99% PPV, 94% NPV, 96% sensitivity, and 99% specificity, whereas VAB demonstrated a 100% PPV, 100% NPV, 100% sensitivity, and 100% specificity. The correct diagnosis in CNB was proportional to the number of cores extracted, whereas accuracy of VAB was independent of the total number of cores taken. There was a positive correlation between the presence of calcification and malignancy in CNB, but not detected under VAB. CNB and VAB were equally efficient in palpable lesions, in detecting necrosis, and calcification. Large calcification was found to be associated with malignancy in both CNB and VAB. In non-palpable lesions, VAB was more effective in the detection of calcification. The diagnostic accuracy of VAB appeared to be independent of number of cores sampled, whereas CNB required a minimum of 3-4 cores to achieve high diagnostic accuracy.
在术前诊断乳腺病变方面，现在针吸活检是首选的初始检查方法。这包括核心针活检（CNB）和真空辅助活检（VAB），有或没有放射学辅助。评估了这两种活检技术的性能指标。在包括 464 例（285 例 CNB 和 179 例 VAB）乳腺病变患者的大队列中，根据所取核心总数、含有乳腺实质的核心和含有病变的核心对活检结果进行了定量评估，并比较了基于确认结果的诊断准确性，非上皮性改变包括坏死和钙化。CNB 的阳性预测值（PPV）为 99%，阴性预测值（NPV）为 94%，敏感度为 96%，特异性为 99%，而 VAB 的 PPV 为 100%，NPV 为 100%，敏感度为 100%，特异性为 100%。CNB 的正确诊断与所取核心数量成正比，而 VAB 的准确性与所取核心总数无关。在 CNB 中，钙化的存在与恶性程度呈正相关，但在 VAB 中未检测到。CNB 和 VAB 在可触及病变、检测坏死和钙化方面同样有效。在 CNB 和 VAB 中，大钙化均与恶性肿瘤相关。在不可触及的病变中，VAB 更有利于检测钙化。VAB 的诊断准确性似乎与所取样本核心数无关，而 CNB 需要至少 3-4 个核心才能达到高诊断准确性。
