Frayne J, Sterrett G F, Harvey J, Goodwin P, Townsend J, Ingram D, Parsons R W
University of Western Australia.
Aust N Z J Surg. 1996 Sep;66(9):585-91. doi: 10.1111/j.1445-2197.1996.tb00824.x.
Along with fine needle aspiration (FNA) cytology, core-biopsy has become an integral part of the assessment of mammographically detected breast lesions.
A series of stereotactic large-core-biopsies of mammographically detected breast lesions was studied to assess the accuracy and limitations of the technique in diagnosing malignancy and in giving specific benign diagnoses, and its use in determining surgical management.
Eighty per cent of carcinomas were diagnosed as malignant (absolute sensitivity). In 88.8% of the cancers, the core-biopsy was classified as malignant, suspicious or atypical/indeterminate (complete sensitivity), and in 72% of the invasive carcinomas, invasive tumour was present in the core. The technique was more successful for invasive carcinomas than for ductal carcinoma in situ (DCIS) (absolute sensitivity 86.1 and 55.5, respectively; P = 0.28) and for malignant mass lesions than for a mass with associated microcalcifications or for pure microcalcifications (absolute sensitivity 91, 71 and 66.6%, respectively; P = 0.19). In five of the 45 cancers (11.1%), no tumour tissue was present in the core, but all were excised after mammographic review and no delays in diagnosis have been experienced to date. The benign to malignant ratio for excised lesions was 0.11:1. Of the benign lesions, a specific diagnosis was given in 49% (calcifications in the core in a background of fibrocystic change, or postoperative scarring, or fibro-adenoma); the remainder showed non-specific benign findings. All patients where invasive carcinoma was diagnosed in the core underwent axillary clearance and wide local excision or mastectomy at their first operation.
This technique can markedly reduce the number of benign lesions needing open biopsy, and provide information allowing definitive management of most carcinomas at the first operation. The accuracy of core-biopsy was lower in DCIS/microcalcification lesions; extra core samples or a combination of FNA and core-biopsy may be of value in these cases.
粗针活检与细针穿刺抽吸（FNA）细胞学检查一起，已成为乳腺钼靶检测出的乳腺病变评估中不可或缺的一部分。
对一系列乳腺钼靶检测出的乳腺病变进行立体定向粗针活检，以评估该技术在诊断恶性肿瘤、做出特定良性诊断方面的准确性和局限性，以及其在确定手术治疗方案中的应用。
80%的癌被诊断为恶性（绝对敏感性）。在88.8%的癌症中，粗针活检被分类为恶性、可疑或非典型/不确定（完全敏感性），在72%的浸润性癌中，粗针中有浸润性肿瘤。该技术对浸润性癌比对原位导管癌（DCIS）更成功（绝对敏感性分别为86.1和55.5；P = 0.28），对恶性肿块病变比对伴有微钙化的肿块或纯微钙化更成功（绝对敏感性分别为91%、71%和66.6%；P = 0.19）。在45例癌症中的5例（11.1%），粗针中没有肿瘤组织，但在乳腺钼靶复查后均进行了切除，迄今为止没有出现诊断延迟。切除病变的良恶性比例为0.11:1。在良性病变中，49%给出了特定诊断（纤维囊性变背景下的核心钙化、或术后瘢痕、或纤维腺瘤）；其余显示非特异性良性表现。所有粗针中诊断为浸润性癌的患者在首次手术时均进行了腋窝清扫和广泛局部切除或乳房切除术。
该技术可显著减少需要进行开放活检的良性病变数量，并提供信息以便在首次手术时对大多数癌症进行确定性治疗。粗针活检在DCIS/微钙化病变中的准确性较低；在这些情况下，额外的粗针样本或FNA与粗针活检的联合应用可能有价值。
