Ciatto S, Rosselli Del Turco M
Centro per lo Studio e la Prevenzione Oncologica, Firenze.
Chir Ital. 1995;47(4):5-8.
Mammography is the most sensitive test for non-palpable lesions, but its specificity is quite limited. When a decision for biopsy is based only on the mammographic appearance the benign/malignant biopsy ratio (B/M) is around 3:1. The B/M varies according to the radiological pattern being favourable for stellate opacities, high for regular opacities, and intermediate for distortions and microcalcifications. Aspiration cytology of non-palpable lesions, either sonographically or stereotaxically guided, is highly accurate. When the decision for surgical biopsy is taken also on the basis of cytology, B/M may be reduced by up to 0.5:1. As false negatives are expected for cytology, lesions which are strongly suspicious at mammography must be biopsied anyway. Sonography guided aspiration is possible in about a half of mammographically detected non-palpable lesions, particularly for opacities, whereas distortions and microcalcification are seldom visualized at sonography. Cytology should be routinely performed in the presence of questionable non-palpable lesions.
乳房X线摄影是检测不可触及病变最敏感的检查方法，但其特异性相当有限。若仅根据乳房X线摄影表现决定是否进行活检，良性/恶性活检比例（B/M）约为3:1。B/M会因放射学表现而异，星芒状混浊的B/M较为有利，规则混浊的B/M较高，而变形和微钙化的B/M处于中间水平。对不可触及病变进行超声引导或立体定向引导下的细针穿刺抽吸活检，其准确性很高。若也根据细胞学检查结果决定是否进行手术活检，B/M可降至0.5:1。由于细针穿刺抽吸活检可能出现假阴性结果，因此无论如何，乳房X线摄影高度可疑的病变都必须进行活检。在乳房X线摄影检测出的约一半不可触及病变中，尤其是对于混浊病变，可进行超声引导下的抽吸活检，而变形和微钙化在超声检查中很少能被看到。对于可疑的不可触及病变，应常规进行细胞学检查。
