Department of Surgery, Adelaide and Meath Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland.
Breast J. 2012 Mar-Apr;18(2):103-10. doi: 10.1111/j.1524-4741.2012.01223.x.
The objective of this study was to make an assessment of the utility of fine needle aspiration cytology (FNAC), in a "one-stop" symptomatic breast triple assessment clinic. Controversy surrounds the optimal tissue biopsy methodology in the diagnosis of symptomatic breast cancer and the identification of benign disease. FNAC in the context of a Rapid Assessment Breast Clinic (RABC) allows the same day diagnosis and early treatment of breast cancer, with the immediate reassurance and discharge of those with benign disease. We analyzed prospective data accrued at a RABC, over a 4-year period from 2004 to 2007. All patients were triple assessed, with FNACs performed on site by two consultant cytopathologists. Investigations were reported immediately, and clinical data were captured via a database using compulsory data field entry. There were 4487 attendances at our RABC, with 1572 FNACs were performed. The positive predictive value of FNAC with a C5 cancer diagnosis was 100%, 95.6% for a C4 report, with a complete sensitivity of 94%. The full specificity of correctly identified benign lesions was 77.4%, with a false negative rate of 3.85%. This enabled 66% of patients attending the RABC to receive a same day diagnosis of benign disease and discharge. FNAC is highly accurate in the diagnosis of symptomatic breast cancer in an RABC. FNAC allows accurate diagnosis of benign disease and immediate discharge of the majority of patients. In this era, when a large majority of patients have benign disease, we believe that FNAC provides an equivalent, if not better, method of evaluation of patients in a triple assessment RABC.
本研究旨在评估细针穿刺细胞学检查（FNAC）在“一站式”症状性乳腺三联评估门诊中的应用价值。在诊断症状性乳腺癌和确定良性疾病方面，哪种组织活检方法最佳存在争议。在快速评估乳腺诊所（RABC）中进行 FNAC 检查，可在当天诊断乳腺癌并进行早期治疗，同时为良性疾病患者提供即时安心和出院。我们分析了 2004 年至 2007 年 4 年间在 RABC 积累的前瞻性数据。所有患者均进行三联评估，由两名顾问细胞病理学家在现场进行 FNAC 检查。检查结果立即报告，并通过数据库使用强制性数据字段输入捕获临床数据。我们的 RABC 共接待了 4487 名患者，其中进行了 1572 次 FNAC 检查。C5 癌症诊断的 FNAC 阳性预测值为 100%，C4 报告的阳性预测值为 95.6%，完全敏感性为 94%。正确识别良性病变的完全特异性为 77.4%，假阴性率为 3.85%。这使得 66%的 RABC 就诊患者能够当天诊断出良性疾病并出院。FNAC 在 RABC 中诊断症状性乳腺癌具有高度准确性。FNAC 可准确诊断良性疾病并使大多数患者立即出院。在这个大多数患者都患有良性疾病的时代，我们认为 FNAC 为在三联评估 RABC 中评估患者提供了一种等效（如果不是更好）的方法。
