Rubin M, Horiuchi K, Joy N, Haun W, Read R, Ratzer E, Fenoglio M
Department of Surgery, St. Joseph Hospital, Denver, Colorado 80218, USA.
Am J Surg. 1997 Dec;174(6):694-6; discussion 697-8. doi: 10.1016/s0002-9610(97)00192-x.
Palpable breast tumors have traditionally been diagnosed with open biopsy or core biopsy. We propose fine needle aspiration biopsy (FNA) as a reliable, cost-saving initial procedure in these patients.
Eighty-five palpable solid breast masses of the breast in 85 patients were classified by a combination of physical examination, mammography, and/or ultrasound as probably benign, indeterminate, or highly suspicious for cancer. All tumors had FNA biopsies. All patients had either a confirmatory open biopsy (55) or close clinical follow-up (30) with a mean follow-up of 29 months (range 6 to 36).
Thirty-four patients classified as clinically benign had a benign FNA biopsy. No cancers were detected in this group by either open surgical biopsy or clinical follow-up. Twenty patients were classified clinically as indeterminate. All had FNA biopsies, and 6 were either positive for cancer or suspicious for cancer. Fourteen patients had negative FNA biopsies. Five of the 6 abnormal biopsies had cancer on open biopsies. The 1 false-positive result occurred in a lactating patient. Thirty-one patients were classified clinically as highly suspicious for cancer. Twenty-three were confirmed as cancer with FNA biopsy. Eight needed open surgical biopsy to confirm cancer. All 31 patients clinically suspicious for cancer had cancer. In patients classified clinically as highly suspicious or probably benign, FNA was a reliable first diagnostic step (100% positive predictive value, 100% specificity, 87% sensitivity, and 89% negative predictive value).
Fine needle aspiration biopsy of solid palpable breast lesions should be the diagnostic procedure of choice for those patients classified clinically as probably benign or clinically as highly suspicious for cancer. Cost analysis revealed elimination of an open biopsy in such cases would save $1,100 per patient. For highly suspicious cases, a negative fine needle aspiration should not deter an open surgical biopsy. For patients classified as indeterminate, fine needle aspiration biopsy results are not reliable enough to determine treatment.
传统上，可触及的乳腺肿瘤通过开放活检或粗针活检进行诊断。我们建议将细针穿刺活检（FNA）作为这些患者可靠且节省成本的初始检查方法。
对85例患者的85个可触及的乳腺实性肿块，通过体格检查、乳房X线摄影和/或超声检查相结合的方式，将其分类为可能良性、不确定或高度怀疑为癌症。所有肿瘤均进行了FNA活检。所有患者均接受了确诊性开放活检（55例）或密切的临床随访（30例），平均随访时间为29个月（范围6至36个月）。
34例临床分类为良性的患者FNA活检结果为良性。该组患者通过开放手术活检或临床随访均未检测到癌症。20例患者临床分类为不确定。所有患者均进行了FNA活检，其中6例癌症检测呈阳性或可疑。14例患者FNA活检结果为阴性。6例异常活检中有5例开放活检确诊为癌症。1例假阳性结果出现在一名哺乳期患者中。31例患者临床分类为高度怀疑为癌症。23例通过FNA活检确诊为癌症。8例需要开放手术活检以确诊癌症。所有31例临床怀疑为癌症的患者均患有癌症。在临床分类为高度怀疑或可能良性的患者中，FNA是可靠的首要诊断步骤（阳性预测值100%，特异性100%，敏感性87%，阴性预测值89%）。
对于临床分类为可能良性或高度怀疑为癌症的患者，可触及乳腺实性病变的细针穿刺活检应作为首选的诊断方法。成本分析显示，在此类病例中省去开放活检，每位患者可节省1100美元。对于高度怀疑的病例，FNA结果为阴性不应妨碍进行开放手术活检。对于分类为不确定的患者，FNA活检结果不足以可靠地确定治疗方案。
