Bellantone R, Rossi S, Lombardi C P, Cinini C, Minelli S, Crucitti F
Institute of Clinical Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
Int Surg. 1995 Jan-Mar;80(1):75-8.
On 673 consecutive patients, excisional biopsy was performed on an outpatient basis using local anesthesia when a palpable breast lump was thought to be benign on clinical, mammographic and cytologic grounds (213 cases) or when the suspicion of cancer was low (100 cases). General anesthesia was performed when the mass was considered to be malignant or highly suspicious for cancer (360 cases). The percentage of correct preoperative diagnosis of benignancy was 96.2% (12 cancers in the outpatient group) and that of malignancy was 98.1% (7 benign lesions in the inpatient group). These data indicate that in the absence of malignant or highly suspicious preoperative findings breast biopsy should be performed under local anesthesia: it is a safe and more economical procedure in terms of medical costs, surgeon's time and patient's anxiety. On 60 patients breast biopsy was performed for non palpable breast lesions detected by mammography. Nineteen cancers were found (35%): the highest percentage was in stellate opacities and in highly suspicious microcalcifications (positive predictive value-PPV-of 45% and 50%, respectively). No cancer was detected in low density masses and in non suspicious calcifications: so, in such patients biopsy should not be recommended for the unacceptable overall biopsy cost.
对673例连续患者进行了切除活检。当根据临床、乳腺X线摄影和细胞学检查结果认为可触及的乳腺肿块为良性时（213例），或怀疑癌症可能性较低时（100例），在门诊采用局部麻醉进行切除活检。当肿块被认为是恶性或高度怀疑为癌症时（360例），则采用全身麻醉。术前对良性病变诊断正确的百分比为96.2%（门诊组中有12例癌症），对恶性病变诊断正确的百分比为98.1%（住院组中有7例良性病变）。这些数据表明，在术前没有恶性或高度可疑表现的情况下，乳腺活检应在局部麻醉下进行：就医疗费用、外科医生的时间和患者的焦虑而言，这是一种安全且更经济的方法。对60例患者进行了乳腺活检，以检查乳腺X线摄影发现的不可触及的乳腺病变。发现了19例癌症（35%）：最高比例出现在星芒状混浊和高度可疑的微钙化中（阳性预测值分别为45%和50%）。在低密度肿块和非可疑钙化中未检测到癌症：因此，对于此类患者，由于总体活检成本过高，不建议进行活检。
