Tavassoli F A, Pestaner J P
Department of Pathology, Fairfax Hospital, Falls Church, Virginia, USA.
Mod Pathol. 1995 May;8(4):380-3.
Fine-needle aspiration, stereotactic biopsies, and guide wire localization have introduced an element of pre-excision trauma to mammary lesions. Dislodgement of tumor cells may result in diagnostic difficulties and misinterpretation of a tissue artifact as an invasive carcinoma. Eight breast biopsy specimens with intraductal carcinoma (ranging from cribriform to comedo types) displayed changes suggestive of an invasive carcinoma. Three of the patients had a prior history of needle aspiration; the remaining five women had undergone needle localization to guide the biopsy. In all cases, two or more dislodged tumor cell clusters were found in the stroma or adipose tissue either immediately adjacent to a disrupted duct with intraductal carcinoma or in the nearby stroma. Those cases with prior needle aspiration were associated with significant hemorrhage and reactive changes with small, rounded clusters of tumor cells within pools of blood. The needle localization specimens had minimal tissue reaction with larger fragments of detached cell clusters. Breast trauma by a puncturing instrument (needle or guide wire) can disrupt mammary ducts with intraductal carcinoma and dislodge the proliferating cells into the surrounding stroma. The dislodged cells simulate invasion. To minimize damage to the architectural integrity of the lesion under investigation, limits should be imposed on the number of needle passes.
细针穿刺、立体定向活检和导丝定位给乳腺病变带来了切除前创伤因素。肿瘤细胞的移位可能导致诊断困难，并将组织假象误判为浸润性癌。八例导管内癌（从筛状型到粉刺型）的乳腺活检标本显示出提示浸润性癌的改变。其中三名患者有针吸活检病史；其余五名女性接受了针定位以指导活检。在所有病例中，在紧邻伴有导管内癌的破裂导管的间质或脂肪组织中，或在附近的间质中，发现了两个或更多移位的肿瘤细胞簇。那些有针吸活检病史的病例伴有大量出血和反应性改变，血液池中可见小而圆的肿瘤细胞簇。针定位标本的组织反应最小，有较大的分离细胞簇碎片。穿刺器械（针或导丝）造成的乳腺创伤可破坏伴有导管内癌的乳腺导管，并使增殖细胞移位到周围间质中。移位的细胞模拟浸润。为尽量减少对所研究病变结构完整性的损害，应限制针穿刺的次数。
