Łukasiewicz Ewa, Ziemiecka Agnieszka, Jakubowski Wiesław, Vojinovic Jelena, Bogucevska Magdalena, Dobruch-Sobczak Katarzyna
Department of Medical Imaging, Mazovia Brodnowski Hospital, Warsaw, Poland.
Department of Ultrasonography and Mammography, Mazovia Brodnowski Hospital, Warsaw, Poland.
J Ultrason. 2017 Dec;17(71):267-274. doi: 10.15557/JoU.2017.0039. Epub 2017 Dec 29.
The aim of the study was to review two techniques that can be used to verify focal lesions in the breasts: fine-needle aspiration biopsy and core-needle biopsy.
Fifty-five articles (original papers and reviews), half of them published within the past 5 years, were included in the analysis. The authors also took their own experience into account.
Pre-operative assessment of focal lesions in the breasts is crucial in the planning of further therapeutic management. The role of fine-needle aspiration biopsy has been reduced lately due to its low sensitivity and specificity as well as a high rate of non-diagnostic, suspicious and false negative results. This method does not enable one to differentiate between in situ and invasive disease. Currently, fine-needle biopsy is recommended for cystic lesions, suspected of being recurrences in the chest wall, and lymph node metastases. Core-needle biopsy is the basic diagnostic method of breast lesions. According to the recommendations of the Polish Ultrasound Society and American College of Radiology, BIRADS 4 and 5 lesions should be evaluated histopathologically. Core-needle biopsy makes it possible to establish a final diagnosis more frequently than fine-needle biopsy, both in the case of benign and malignant lesions. It delivers more information about the nature of a tumor (mutation of HER-2, estrogen and progesterone receptors and Ki-67 index). Its limitations include: underestimation of invasion and failure to recognize the components of ductal carcinoma in situ in papillary and atypical lesions. Single fine-needle aspiration biopsy is inexpensive, but when considering the cost of further diagnosis due to non-diagnostic, suspicious and atypical results, this method generates high additional costs.
Microscopic verification of focal breast lesions is crucial for further therapeutic decisions. It has been proven that histopathological verification is more accurate and has more advantages than cytological assessment.
本研究旨在回顾两种可用于验证乳腺局灶性病变的技术：细针穿刺活检和粗针穿刺活检。
分析纳入了55篇文章（原始论文和综述），其中一半在过去5年内发表。作者还考虑了自身经验。
乳腺局灶性病变的术前评估对于进一步治疗方案的规划至关重要。细针穿刺活检的作用近来有所降低，因其敏感性和特异性较低，以及非诊断性、可疑和假阴性结果的发生率较高。该方法无法区分原位癌和浸润性疾病。目前，细针活检推荐用于囊性病变、怀疑为胸壁复发以及淋巴结转移的情况。粗针穿刺活检是乳腺病变的基本诊断方法。根据波兰超声学会和美国放射学会的建议，BIRADS 4和5类病变应进行组织病理学评估。粗针穿刺活检在良性和恶性病变中都比细针穿刺活检更频繁地能够做出最终诊断。它能提供更多关于肿瘤性质的信息（HER-2、雌激素和孕激素受体的突变以及Ki-67指数）。其局限性包括：低估浸润情况以及在乳头状和非典型病变中未能识别原位导管癌的成分。单次细针穿刺活检成本低廉，但由于非诊断性、可疑和非典型结果而考虑进一步诊断的成本时，该方法会产生高昂的额外费用。
乳腺局灶性病变的显微镜检查对于进一步的治疗决策至关重要。已证明组织病理学检查比细胞学评估更准确且具有更多优势。
