Masood S, Frykberg E R, McLellan G L, Scalapino M C, Mitchum D G, Bullard J B
Department of Pathology, University of Florida Health Science Center, Jacksonville.
Cancer. 1990 Oct 1;66(7):1480-7. doi: 10.1002/1097-0142(19901001)66:7<1480::aid-cncr2820660708>3.0.co;2-o.
The application of fine-needle aspiration biopsy (FNAB) to the diagnosis of nonpalpable breast lesions was evaluated with a new method which uses standard needle localization under mammographic guidance to assure accurate sampling by FNAB. This method was prospectively applied to 100 mammographically detected breast lesions in 100 women (mean age, 53 years). All 100 patients underwent surgical excision of these nonpalpable lesions after cytologic aspiration. Sufficient aspirated material was obtained for cytologic diagnosis from 91 patients (91%). The histologic and cytologic interpretations were then compared. Twenty malignancies were ultimately diagnosed by histology (12 invasive ductal carcinoma, six ductal carcinoma in situ, and two lobular carcinoma in situ), of which 17 had been cytologically diagnosed. There were no false-positive diagnoses of malignancy by FNAB. False-negative readings (3.3%) included two cases of lobular carcinoma in situ and one case of ductal carcinoma in situ. This technique thus demonstrated a sensitivity of 85%, specificity of 100%, and overall diagnostic accuracy of 96.7% for the nonsurgical detection of malignancy in nonpalpable breast lesions. These results suggest that the established safety, reliability, and cost-effectiveness of FNAB can be maintained in this clinical setting. This procedure may obviate the need for open surgical biopsy in those patients with an unequivocal diagnosis of malignancy. It can also be done using standard techniques and equipment available in many community hospitals.
采用一种新方法对细针穿刺活检（FNAB）在不可触及乳腺病变诊断中的应用进行了评估，该方法在乳腺钼靶引导下使用标准针定位，以确保FNAB进行准确采样。该方法前瞻性地应用于100名女性（平均年龄53岁）的100个经乳腺钼靶检测出的乳腺病变。所有100例患者在进行细胞抽吸后均接受了这些不可触及病变的手术切除。91例患者（91%）获得了足够用于细胞学诊断的抽吸材料。然后比较组织学和细胞学解释。最终经组织学诊断出20例恶性肿瘤（12例浸润性导管癌、6例导管原位癌和2例小叶原位癌），其中17例经细胞学诊断。FNAB未出现恶性肿瘤的假阳性诊断。假阴性结果（3.3%）包括2例小叶原位癌和1例导管原位癌。因此，该技术对不可触及乳腺病变中恶性肿瘤的非手术检测显示出85%的敏感性、100%的特异性和96.7%的总体诊断准确性。这些结果表明，在这种临床情况下，FNAB既定的安全性、可靠性和成本效益可以得到保持。对于那些已明确诊断为恶性肿瘤的患者，该操作可能无需进行开放性手术活检。而且它可以使用许多社区医院现有的标准技术和设备来完成。
