Departmant of Breast Surgery of Guangxi Cancer Hospital & Affiliated Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi, P.R.China.
BMC Cancer. 2012 Jan 25;12:41. doi: 10.1186/1471-2407-12-41.
Fine-needle aspiration biopsy (FNAB) of the breast is a minimally invasive yet maximally diagnostic method. However, the clinical use of FNAB has been questioned. The purpose of our study was to establish the overall value of FNAC in the diagnosis of breast lesions.
After a review and quality assessment of 46 studies, sensitivity, specificity and other measures of accuracy of FNAB for evaluating breast lesions were pooled using random-effects models. Summary receiver operating characteristic curves were used to summarize overall accuracy. The sensitivity and specificity for the studies data (included unsatisfactory samples) and underestimation rate of unsatisfactory samples were also calculated.
The summary estimates for FNAB in diagnosis of breast carcinoma were as follows (unsatisfactory samples was temporarily exluded): sensitivity, 0.927 (95% confidence interval [CI], 0.921 to 0.933); specificity, 0.948 (95% CI, 0.943 to 0.952); positive likelihood ratio, 25.72 (95% CI, 17.35 to 28.13); negative likelihood ratio, 0.08 (95% CI, 0.06 to 0.11); diagnostic odds ratio, 429.73 (95% CI, 241.75 to 763.87); The pooled sensitivity and specificity for 11 studies, which reported unsatisfactory samples (unsatisfactory samples was considered to be positive in this classification) were 0.920 (95% CI, 0.906 to 0.933) and 0.768 (95% CI, 0.751 to 0.784) respectively. The pooled proportion of unsatisfactory samples that were subsequently upgraded to various grade cancers was 27.5% (95% CI, 0.221 to 0.296).
FNAB is an accurate biopsy for evaluating breast malignancy if rigorous criteria are used. With regard to unsatisfactory samples, futher invasive procedures are required in order to minimize the chance of a missed diagnosis of breast cancer.
细针穿刺活检（FNAB）是一种微创但最大程度上具有诊断性的方法。然而，FNAB 的临床应用一直受到质疑。我们研究的目的是确定 FNAC 在诊断乳腺病变中的总体价值。
对 46 项研究进行了回顾和质量评估，使用随机效应模型汇总 FNAB 评估乳腺病变的准确性的敏感度、特异度和其他指标。使用综合受试者工作特征曲线来总结总体准确性。还计算了研究数据（包括不满意样本）的敏感度和特异度以及不满意样本的低估率。
FNAB 诊断乳腺癌的汇总估计值如下（暂时排除不满意样本）：敏感度，0.927（95%置信区间 [CI]，0.921 至 0.933）；特异度，0.948（95%CI，0.943 至 0.952）；阳性似然比，25.72（95%CI，17.35 至 28.13）；阴性似然比，0.08（95%CI，0.06 至 0.11）；诊断比值比，429.73（95%CI，241.75 至 763.87）；11 项报告不满意样本的研究（在这种分类中，不满意样本被认为是阳性）的汇总敏感度和特异度分别为 0.920（95%CI，0.906 至 0.933）和 0.768（95%CI，0.751 至 0.784）。不满意样本随后升级为各种等级癌症的汇总比例为 27.5%（95%CI，0.221 至 0.296）。
如果使用严格的标准，FNAB 是评估乳腺恶性肿瘤的一种准确的活检方法。对于不满意的样本，需要进一步的侵入性程序，以最大程度地减少漏诊乳腺癌的机会。
