根据组织学类型评估乳腺癌细胞学检查中不充分、不确定、假阴性和假阳性病例。
Evaluation of inadequate, indeterminate, false-negative and false-positive cases in cytological examination for breast cancer according to histological type.
机构信息
Department of Pathology, Kurume University Medical Center, Kurume, Japan.
出版信息
Diagn Pathol. 2012 May 18;7:53. doi: 10.1186/1746-1596-7-53.
BACKGROUND
We previously investigated the current status of breast cytology cancer screening at seven institutes in our area of southern Fukuoka Prefecture, and found some differences in diagnostic accuracy among the institutions. In the present study, we evaluated the cases involved and noted possible reasons for their original cytological classification as inadequate, indeterminate, false-negative and false-positive according to histological type.
METHODS
We evaluated the histological findings in 5693 individuals who underwent cytological examination for breast cancer (including inadequate, indeterminate, false-negative and false-positive cases), to determine the most common histological types and/or features in these settings and the usefulness/limitations of cytological examination for the diagnosis of breast cancer.
RESULTS
Among 1152 cytologically inadequate cases, histology revealed that 75/173 (43.6%) cases were benign, including mastopathy (fibrocystic disease) in 38.6%, fibroadenoma in 24.0% and papilloma in 5.3%. Ninety-five of 173 (54.9%) cases were histologically malignant, with scirrhous growing type, invasive ductal carcinoma (SIDC) being significantly more frequent (49.5%) than papillotubular growing type (Papi-tub) (P < 0.0001), solid-tubular growing type (P = 0.0001) and ductal carcinoma in situ (DCIS) (P = 0.0001). Among 458 indeterminate cases, 54/139 (38.8%) were histologically benign (mastopathy, 30.0%; fibroadenoma, 27.8%; papilloma, 26.0%) and 73/139 (52.5%) were malignant, with SIDC being the most frequent malignant tumor (37.0%). Among 52 false-negative cases, SIDC was significantly more frequent (42.3%) than DCIS (P = 0.0049) and Papi-tub (P = 0.001). There were three false-positive cases, with one each of fibroadenoma, epidermal cyst and papilloma.
CONCLUSIONS
The inadequate, indeterminate, false-negative and false-positive cases showed similar histological types, notably SIDC for malignant tumors, and mastopathy, fibroadenoma and papilloma for benign cases. We need to pay particular attention to the collection and assessment of aspirates for these histological types of breast disease. In particular, several inadequate, indeterminate and false-negative cases with samples collected by aspiration were diagnosed as SIDC. These findings should encourage the use of needle biopsy rather than aspiration when this histological type is identified on imaging. Namely, good communication between clinicians and pathological staff, and triple assessment (i.e., clinical, pathological and radiological assessment), are important for accurate diagnosis of aspiration samples.
VIRTUAL SLIDES
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/7349809170055423.
背景
我们之前在本地区南部福冈县的 7 家医院调查了乳腺癌细胞学筛查的现状，发现各机构之间的诊断准确性存在差异。在本研究中，我们评估了涉及的病例，并根据组织学类型对其细胞学分类不足、不确定、假阴性和假阳性的原因进行了分析。
方法
我们评估了 5693 例接受乳腺癌细胞学检查（包括细胞学分类不足、不确定、假阴性和假阳性病例）的患者的组织学发现，以确定这些情况下最常见的组织学类型和/或特征，以及细胞学检查对乳腺癌诊断的有用性/局限性。
结果
在 1152 例细胞学不足的病例中，组织学显示 75/173（43.6%）例为良性，其中乳腺病（纤维囊性疾病）占 38.6%，纤维腺瘤占 24.0%，乳突瘤占 5.3%。173 例中有 95 例（54.9%）为组织学恶性，其中硬癌型生长方式更为常见（49.5%），明显高于乳突型生长方式（Papi-tub）（P < 0.0001）、实性管状生长方式（P = 0.0001）和导管原位癌（DCIS）（P = 0.0001）。在 458 例不确定的病例中，54/139（38.8%）为组织学良性（乳腺病，30.0%；纤维腺瘤，27.8%；乳突瘤，26.0%），73/139（52.5%）为恶性，其中硬癌型生长方式最常见（37.0%）。在 52 例假阴性病例中，硬癌型生长方式明显更为常见（42.3%），明显高于 DCIS（P = 0.0049）和 Papi-tub（P = 0.001）。有 3 例假阳性病例，分别为纤维腺瘤、表皮囊肿和乳突瘤各 1 例。
结论
细胞学分类不足、不确定、假阴性和假阳性病例的组织学类型相似，恶性肿瘤主要为硬癌型，良性病例主要为乳腺病、纤维腺瘤和乳突瘤。我们需要特别注意这些乳腺疾病的组织学类型的标本采集和评估。特别是，一些经抽吸获得的细胞学分类不足、不确定和假阴性的样本被诊断为硬癌型。这些发现应鼓励在影像学检查发现这种组织学类型时使用针吸活检而不是抽吸。即临床医生和病理工作人员之间的良好沟通，以及临床、病理和影像学评估的三联评估，对于准确诊断抽吸样本非常重要。
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