Costa M J, Tadros T, Hilton G, Birdsong G
Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia.
Acta Cytol. 1993 Jul-Aug;37(4):461-71.
We examined breast fine needle aspiration cytology's role as a screening tool in addition to mammography and clinical examination for palpable breast lesions, circumventing operative biopsy of benign lesions while identifying cancer for definitive treatment and significant ductal proliferations that need histologic evaluation, such as atypical ductal hyperplasia and marked ductal hyperplasia. Five hundred thirty-three consecutive palpable breast lesions in 498 patients referred to cytopathologists were aspirated and the cytologic findings reported as follows: (1) malignant, treat as any histologic diagnosis of breast cancer (85); (2) suspicious, intraoperative or biopsy confirmation before therapy (11); (3) atypical, biopsy recommended to exclude breast cancer or significant ductal proliferation (atypical ductal hyperplasia and marked ductal hyperplasia) (45); (4) benign, excision not necessary (334); and (5) nondiagnostic, no ductal cells, and biopsy recommended if indicated clinically (58). Excision of 57/85 malignant lesions confirmed cancer in all cases. Follow-up of the remaining 28 patients showed: 17 were undergoing treatment for cancer without surgery, 8 were dead of the disease, and 3 were lost to follow-up. Biopsy of 11/11 suspicious lesions confirmed cancer. Biopsy of 27/45 atypical lesions showed: 1 carcinoma, 12 significant ductal proliferations (1 atypical ductal hyperplasia and 11 marked ductal hyperplasia) and 14 benign, nonproliferative breasts; 18 atypical lesions from 14 patients were not biopsied. Biopsy of 61/334 benign lesions showed 51 benign nonproliferative breasts, 7 missed significant ductal proliferations (6 marked ductal hyperplasia and 1 atypical ductal hyperplasia) and 3 false negatives (3 carcinomas). The three false negatives and the atypical ductal hyperplasia had a biopsy because of an abnormal mammogram. Review of material from false-negative cases showed underinterpretation of cells present on cytology slides in two cases and carcinoma missed by the aspiration needle in one case. The atypical ductal hyperplasia was in a separate, nonpalpable area in the same breast. Biopsy was avoided in 273/334 benign lesions from 249 patients: 86 had no follow-up, 160 had stable lesions, and 3 reported a change in their lesions (mean follow-up, 13 months). One of these three had a biopsy that showed a benign, nonproliferative breast. Biopsy of 11/58 nondiagnostic lesions showed 9 benign nonproliferative breasts, 1 atypical ductal hyperplasia and 1 carcinoma. No biopsy was performed on 47/58 nondiagnostic lesions from 45 patients: 1 had a repeat aspiration that was malignant, 10 had no follow-up, 33 had stable lesions, and 1 had an increase in the size of her lesion (mean follow-up, 13 months).(ABSTRACT TRUNCATED AT 400 WORDS)
我们研究了乳腺细针穿刺细胞学检查作为一种筛查工具，在乳腺钼靶摄影和临床检查之外，对于可触及乳腺病变的作用，旨在避免对良性病变进行手术活检，同时识别出需要进行确定性治疗的癌症以及需要组织学评估的显著导管增生，如非典型导管增生和重度导管增生。对498例患者的533个连续可触及乳腺病变进行了细针穿刺，并将细胞学检查结果报告如下：（1）恶性，按任何乳腺癌组织学诊断进行治疗（85例）；（2）可疑，治疗前需术中或活检确诊（11例）；（3）非典型，建议活检以排除乳腺癌或显著导管增生（非典型导管增生和重度导管增生）（45例）；（4）良性，无需切除（334例）；（5）无法诊断，未见导管细胞，临床有指征时建议活检（58例）。57/85例恶性病变切除术后均确诊为癌症。对其余28例患者的随访显示：17例正在接受非手术癌症治疗，8例死于该疾病，3例失访。11/11例可疑病变活检确诊为癌症。27/45例非典型病变活检结果显示：1例癌，12例显著导管增生（1例非典型导管增生和11例重度导管增生），14例良性、无增生的乳腺组织；14例患者的18例非典型病变未进行活检。61/334例良性病变活检结果显示：51例良性、无增生的乳腺组织，7例漏诊显著导管增生（6例重度导管增生和1例非典型导管增生），3例假阴性（3例癌）。3例假阴性和非典型导管增生因乳腺钼靶摄影异常而进行了活检。对假阴性病例材料的复查显示，2例为细胞学涂片上细胞解读不足，1例为穿刺针漏诊癌。非典型导管增生位于同一乳腺的单独、不可触及区域。249例患者的273/334例良性病变避免了活检：86例未进行随访，160例病变稳定，3例报告病变有变化（平均随访13个月）。这3例中的1例活检显示为良性、无增生的乳腺组织。11/58例无法诊断病变活检结果显示：9例良性、无增生的乳腺组织，1例非典型导管增生和1例癌。45例患者的47/58例无法诊断病变未进行活检：1例重复穿刺为恶性，10例未进行随访，33例病变稳定，1例病变增大（平均随访13个月）。（摘要截取自400字）
