University of New South Wales Medical School, Notre Dame University Medical School, and Department of Anatomical Pathology, St. Vincent's Hospital, Sydney, Australia.
Department of Surgical Pathology, Flinders Medical Centre and Flinders University of South Australia, and Clinpath Laboratories, Adelaide, Australia.
J Am Soc Cytopathol. 2020 Mar-Apr;9(2):103-111. doi: 10.1016/j.jasc.2019.10.004. Epub 2020 Jan 23.
The present report reviews the current problems associated with the routine use of breast fine needle aspiration biopsy (FNAB) and discusses the potential impact that the new International Academy of Cytology (IAC) Yokohama Reporting System and the use of rapid on-site evaluation (ROSE) should have on reducing these problems to optimize breast care for patients. The recently reported IAC System aims to establish the best practice guidelines for breast FNAB, emphasizing the importance of the FNAB technique and the skillful preparation of direct smears. The IAC System proposes a standardized report and established clear terminology for defined reporting categories, each of which has a risk of malignancy and is linked to management options. The FNAB techniques that will optimize the biopsy specimen and reduce poor quality smears are reviewed and the benefits of ROSE are discussed. FNAB can diagnose accurately the vast majority of breast lesions, and ROSE has been recommended whenever possible to reduce the rate of insufficient/inadequate cases and increase the number of specific benign and malignant diagnoses. ROSE performed by a cytopathologist provides a provisional diagnosis, reducing patient anxiety and facilitating management through cost-effective immediate triage and patient selection for ancillary testing. Thus, patients can be selected for immediate core needle biopsy, as required.
本报告回顾了常规使用乳腺细针抽吸活检（FNAB）相关的当前问题，并讨论了新的国际细胞学学会（IAC）横滨报告系统和快速现场评估（ROSE）的使用可能对减少这些问题以优化患者的乳腺护理产生的潜在影响。最近报道的 IAC 系统旨在为乳腺 FNAB 建立最佳实践指南，强调 FNAB 技术和直接涂片的熟练制备的重要性。IAC 系统提出了标准化报告和定义报告类别的明确术语，每个报告类别都有恶性风险，并与管理选择相关联。审查了优化活检标本和减少质量差涂片的 FNAB 技术，并讨论了 ROSE 的益处。FNAB 可以准确诊断绝大多数乳腺病变，并且只要有可能，就推荐使用 ROSE 来降低不足/不充分病例的比例，并增加特定良性和恶性诊断的数量。细胞病理学家进行的 ROSE 可提供临时诊断，减轻患者焦虑，并通过经济有效的即时分诊和选择进行辅助检查的患者来促进管理。因此，可以根据需要选择患者进行即刻核心针活检。
