van Wyk W F, Dent D M, Hacking E A, Learmonth G, Kottler R E, Gudgeon C A, Tiltman A
Department of Surgery, Groote Schuur Hospital.
S Afr Med J. 1995 Feb;85(2):81-4.
We examined the safety and utility of the combined assessment of aspiration cytology and mammography in 705 women who had clinically suspicious or malignant palpable breast masses. Histological assessment confirmed 176 benign and 529 malignant lesions. There were no incorrect (false positive) diagnoses made in the 176 benign masses when combined assessment was used (specificity 1.0; predictive value 0.86); in isolation, however, there was a false positive cytological diagnosis ('papillary carcinoma') and 3 false positive mammographic diagnoses. Benign disease (false negative) was incorrectly diagnosed by combined assessment in 4 of the 529 malignant masses (sensitivity 0.99; predictive value 0.98): cytological diagnoses were of fat necrosis (2) and benign cells on cytospin (1) and aspiration biopsy (1); mammographic diagnoses were of benign disease (2) and normality (2). Indeterminate ('atypical', 'suspicious') diagnoses were problematic and frequent (overall 223 (31.6%), malignant masses 137 (25.9%), benign masses 86 (48.9%); cytology 117 (16.6%), mammography 141 (20%). Thus, with the combined assessment of mammography and cytology in clinically suspicious breast masses, a decisive diagnosis was made in about two-thirds of cases allowing the safe commencement of therapy; the balance of patients required core or excision biopsy.
我们对705名临床检查怀疑有可触及乳腺肿块或恶性乳腺肿块的女性进行了穿刺细胞学检查和乳房X线摄影联合评估的安全性及实用性研究。组织学评估证实有176个良性病变和529个恶性病变。在对176个良性肿块进行联合评估时，没有出现错误（假阳性）诊断（特异性为1.0；预测值为0.86）；然而，单独进行穿刺细胞学检查时，有1例假阳性细胞学诊断（“乳头状癌”），乳房X线摄影有3例假阳性诊断。在529个恶性肿块中，联合评估将4个误诊为良性疾病（假阴性）（敏感性为0.99；预测值为0.98）：穿刺细胞学诊断为脂肪坏死（2例）、细胞离心涂片良性细胞（1例）和穿刺活检良性细胞（1例）；乳房X线摄影诊断为良性疾病（2例）和正常（2例）。不确定（“非典型”“可疑”）诊断存在问题且很常见（总体223例（31.6%），恶性肿块137例（25.9%），良性肿块86例（48.9%）；细胞学检查117例（16.6%），乳房X线摄影141例（20%））。因此，对于临床怀疑的乳腺肿块，通过乳房X线摄影和细胞学检查联合评估，约三分之二的病例可做出决定性诊断，从而安全地开始治疗；其余患者需要进行粗针活检或切除活检。
