Wanebo H J, Feldman P S, Wilhelm M C, Covell J L, Binns R L
Ann Surg. 1984 May;199(5):569-79. doi: 10.1097/00000658-198405000-00012.
Fine needle aspiration (FNA) can be used in place of open breast biopsy in most patients with primary breast cancer. This report summarizes our experience with 398 patients who had FNA of the breast. There was a total of 136 cancers, of which 100 (74%) were diagnosed by FNA. Seventy-one patients had mastectomy without frozen section. Thirteen had an excisional biopsy before mastectomy by preference of the surgeon. These cases occurred early in this series, before the surgeons became confident in the technique. The presence of locally advanced disease was confirmed by FNA in 12 patients and metastases to the breast were confirmed in four. There were no false-positives. Fine needle aspiration was interpreted as "suspicious" but not diagnostic of malignancy in 31 patients and open biopsy was requested. Biopsies demonstrated primary breast carcinoma in 22 patients and metastatic cancer in one. There were 103 patients with FNA negative for cancer who had open biopsy; 102 were confirmed negative, and one was positive for cancer. Fine needle aspiration yielded insufficient material in 38 patients, and 12 of these were found to have carcinoma with open biopsy. Advantages of FNA: It is safe, atraumatic and rapid, and permits definitive discussion about treatment planning at the initial office visit. It obviates the need for frozen section, reducing anesthesia and operative time. Our experience shows that FNA is highly accurate in the diagnosis of breast malignancy if rigorous criteria are used. Although a negative FNA requires biopsy to exclude malignancy, a FNA that is positive for cancer eliminates the need for open biopsy and allows the surgeon to proceed to mastectomy with confidence.
在大多数原发性乳腺癌患者中，细针穿刺抽吸术（FNA）可替代开放性乳房活检。本报告总结了我们对398例行乳房FNA患者的经验。共有136例癌症，其中100例（74%）通过FNA确诊。71例患者未行冰冻切片检查直接进行了乳房切除术。13例患者根据外科医生的偏好，在乳房切除术前行切除活检。这些病例发生在本系列研究的早期，当时外科医生对该技术还缺乏信心。12例患者经FNA确诊为局部晚期疾病，4例确诊为乳房转移癌。无假阳性结果。31例患者的FNA结果被解释为“可疑”但不能诊断为恶性肿瘤，因此要求进行开放性活检。活检显示22例为原发性乳腺癌，1例为转移性癌。103例FNA结果为癌症阴性的患者进行了开放性活检；102例被证实为阴性，1例为癌症阳性。38例患者FNA获取的材料不足，其中12例经开放性活检发现患有癌症。FNA的优点：安全、无创且快速，并且在初次门诊就诊时就能对治疗方案进行明确的讨论。它无需进行冰冻切片检查，减少了麻醉和手术时间。我们的经验表明，如果使用严格的标准，FNA在诊断乳腺恶性肿瘤方面具有高度准确性。虽然FNA结果为阴性需要活检以排除恶性肿瘤，但FNA结果为癌症阳性则无需进行开放性活检，使外科医生能够自信地进行乳房切除术。
