Rubenchik I, Sneige N, Edeiken B, Samuels B, Fornage B
Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Am J Clin Pathol. 1997 Jul;108(1):13-8.
Pathology-related medical malpractice claims frequently concern fine-needle aspirations (FNAs) of breast lesions, and diagnostic errors have been attributed in part to the inadequacy of the specimens. Cytologic criteria for adequate FNA specimens, specifically in cases without malignancy, have not been clearly defined. From January 1988, to August 1995, 669 ultrasonographic-guided FNAs of nonpalpable, solid breast lesions with subsequent histologic examination were performed at our institution. From these, 54 cases with cytologic diagnoses of insufficient or nonspecific benign findings were identified. All aspirates were reviewed, and the number and size of the epithelial cell groups were quantitated in each case. By using criteria for adequate aspirates of palpable breast lesions (six or more epithelial cell groups per case with a minimum of 5-10 cells per group), 23 of the 54 aspirates were deemed inadequate and 31 adequate. Eleven (48%) of the inadequate aspirates and 17 (55%) of the adequate aspirates were from histologically confirmed carcinomas (ductal carcinoma in situ, 6; invasive carcinoma, 22, of which 12 were ductal, 7, lobular, and 3, mixed ductal and lobular). For the mammographic diagnoses "probably benign," "indeterminate," and "suggestive of malignancy or malignant," the probability of malignancy in aspirates of adequate cellularity (eg, > 6 epithelial groups) was 9%, 40%, and 93%, respectively. These findings indicate that a significant proportion of breast aspirates still may yield false-negative results despite adequate to high cellularity. Although a definition of adequacy based on cellularity is useful in reducing false-negative results, cellularity alone cannot be relied on in the management of nonpalpable lesions. For mammographic findings that are indeterminate or suggestive of malignancy or malignant, nonspecific FNA findings should be followed by core or excisional biopsy to exclude carcinoma.
与病理学相关的医疗事故索赔常常涉及乳腺病变的细针穿刺抽吸活检（FNA），诊断错误部分归因于标本不充分。关于充分的FNA标本的细胞学标准，尤其是在无恶性病变的情况下，尚未明确界定。1988年1月至1995年8月，我们机构对669例不可触及的实性乳腺病变进行了超声引导下FNA，并随后进行了组织学检查。从中，识别出54例细胞学诊断为不充分或非特异性良性结果的病例。对所有抽吸物进行了复查，并对每例中上皮细胞团的数量和大小进行了定量。通过使用可触及乳腺病变充分抽吸物的标准（每例六个或更多上皮细胞团，每组至少5 - 10个细胞），54例抽吸物中有23例被认为不充分，31例充分。不充分抽吸物中有11例（48%），充分抽吸物中有17例（55%）来自组织学确诊的癌（原位导管癌6例；浸润性癌22例，其中12例为导管癌，7例为小叶癌，3例为导管和小叶混合癌）。对于乳腺钼靶诊断为“可能良性”“不确定”和“提示恶性或恶性”的情况，细胞量充足（如> 6个上皮细胞团）的抽吸物中恶性的概率分别为9%、40%和93%。这些发现表明，尽管细胞量充足至高细胞量，但仍有相当比例的乳腺抽吸物可能产生假阴性结果。虽然基于细胞量的充分性定义有助于减少假阴性结果，但在不可触及病变的管理中不能仅依赖细胞量。对于乳腺钼靶检查结果不确定或提示恶性或恶性的情况，非特异性FNA结果之后应进行粗针活检或切除活检以排除癌症。
