Peterse J L, Koolman-Schellekens M A, van de Peppel-van de Ham T, van Heerde P
Department of Pathology, Netherlands Cancer Institute, Amsterdam.
Semin Diagn Pathol. 1989 May;6(2):126-34.
A gray area of uncertainty exists in fine-needle aspiration (FNA) cytology of the breast in which common criteria to distinguish benign from malignant lesions overlap. Aims of this study were to define this area and to evaluate statistically cytomorphologic criteria in a semiquantitative analysis. In a test set of specimens from well-differentiated carcinomas and benign proliferative lesions, signs of malignancy were cell dissociation, arrangement in small clusters, nuclei greater than 16 microns, anisonucleosis, irregular nuclear borders, nucleoli, and necrosis. Features in favor of benignancy were large monolayers, nuclei less than 16 microns without variation in size, smooth nuclear borders, and bipolar nuclei in the monolayers. Originally the term "atypia" had been applied to 956 (12%) of all FNAs of the breast performed at our institute from 1974 to 1985. Using these criteria in a review of all 301 cases in which histologic follow-up and cellular smears were available, much better results were obtained than originally; specificity increased from 80% to 95%, and sensitivity increased from 60% to 90%. The number of overdiagnoses decreased from 24 to seven, and underdiagnoses decreased from 57 to nine. In this selected series, the area of uncertainty was restricted to 16% of the cases; the number of these cases that proved to be malignant and benign was equal. In such cases of indistinct cytomorphologic criteria, a surgical biopsy is indicated for histologic studies.
在乳腺细针穿刺（FNA）细胞学检查中存在一个不确定的灰色区域，区分良性与恶性病变的常见标准相互重叠。本研究的目的是界定这一区域，并在半定量分析中对细胞形态学标准进行统计学评估。在一组来自高分化癌和良性增生性病变的标本测试集中，恶性征象包括细胞解离、小簇状排列、细胞核大于16微米、核大小不均、核边界不规则、核仁以及坏死。提示良性的特征包括大的单层细胞、细胞核小于16微米且大小无变化、核边界光滑以及单层细胞中的双极核。从1974年到1985年在我们研究所进行的所有乳腺FNA中，最初“异型性”一词应用于956例（12%）。在对所有301例有组织学随访和细胞涂片的病例进行复查时使用这些标准，获得了比最初好得多的结果；特异性从80%提高到95%，敏感性从60%提高到90%。过度诊断的数量从24例减少到7例，漏诊数量从57例减少到9例。在这个选定的系列中，不确定区域仅限于16%的病例；这些病例中被证明为恶性和良性的数量相等。在细胞形态学标准不明确的此类病例中，需要进行手术活检以进行组织学研究。
