Place R, Velanovich V, Carter P
Department of Surgery, Madigan Army Medical Center, Tacoma, Washington.
Surg Gynecol Obstet. 1993 Jul;177(1):7-11.
The role of fine needle aspiration (FNA) for clinical decision-making in patients with nodules of the breast remains in evolution. We retrospectively studied FNA outcomes in 183 patients, stratified by decades of age, to determine the reliability of FNA cytologic examination. Using Bayesian analysis, the predictive value of a positive FNA for women more than 60 years of age is 98 to 99 percent. In women 41 to 60 years of age, those with a first-degree relative with carcinoma of the breast and those with a prior biopsy with increased risk have an 88 to 95 percent likelihood of carcinoma. In women younger than 41 years of age, this likelihood decreases to 65 percent. Additionally, the probability of a lump being carcinoma, given the FNA was negative, ranges from 3 to 80 percent. Therefore, biopsy of a dominant nodule should not be deferred based only on a negative FNA. We can conclude that women 61 years of age or older could be counseled for definitive care at the first operation. Women 41 to 60 years of age, those with a positive family history or those with a past biopsy with increased risk, could be counseled for definitive therapy, but have the diagnosis confirmed with frozen section. Women less than 40 years of age without other risk factors receive no diagnostic benefit from FNA and should only be evaluated with open biopsy.
细针穿刺抽吸术（FNA）在乳腺结节患者临床决策中的作用仍在不断演变。我们对183例患者的FNA结果进行了回顾性研究，按年龄 decade 分层，以确定FNA细胞学检查的可靠性。使用贝叶斯分析，60岁以上女性FNA阳性的预测价值为98%至99%。在41至60岁的女性中，有乳腺癌一级亲属以及既往活检显示风险增加的女性患癌可能性为88%至95%。在41岁以下的女性中，这一可能性降至65%。此外，FNA结果为阴性时，肿块为癌的概率在3%至80%之间。因此，不应仅基于FNA阴性而推迟对优势结节进行活检。我们可以得出结论，对于61岁及以上的女性，可在首次手术时建议其接受确定性治疗。对于41至60岁、有阳性家族史或既往活检显示风险增加的女性，可建议其接受确定性治疗，但需通过冰冻切片确诊。对于40岁以下且无其他风险因素的女性，FNA无诊断益处，应仅通过开放活检进行评估。
