Pathological aspects of core needle biopsy for non-palpable breast lesions

Recently, the incidence of non-palpable or noninvasive breast cancer has increased. Consequently, criteria for choosing procedures to obtain pathological materials had changed. Fine needle aspiration biopsy cytology (FNA) and core needle biopsy (CNB) are both reliable procedures for detecting breast cancer. However, for non-palpable lesions, the diagnostic accuracy of CNB is higher. The main limits of FNA are the high rate of insufficient sampling and inability to determine invasiveness. CNB is an established alternative to surgical biopsy, and CNB can avoid excess surgical biopsies in a large number of patients. In addition to accurate histological diagnosis, there is interest in obtaining prognostic information from CNB, especially for patients being considered for preoperative (neoadjuvant) therapy. CNB provides useful information about histologic type and grade. However, an unavoidable problem of CNB is underestimation of invasion. On the other hand, there is good concordance in particular for estrogen receptor (ER) and progesterone receptor (PR) between CNB and surgical excision. Several aspects of CNB remains controversial, such as diagnosing papillary lesions by CNB, problems regarding tumor cell displacement after CNB, and management of lobular neoplasia (LN) on CNB.     

Core wash cytology of breast lesions by ultrasonographically guided core needle biopsy

Previous studies demonstrated that core wash cytology by stereotactic needle biopsy was useful for the immediate diagnosis of breast lesions. The purpose of this study was to assess the accuracy of core wash cytology of breast lesions by ultrasonographically (US) guided core needle biopsy (CNB). US-guided 18-gauge CNB was performed in a series of 458 cases. Each CNB sample was washed in saline solution. Core wash cytology of the washed core material was performed on material obtained by saline solution lavage of the fragments using a cytocentrifuge. The cytological diagnoses were divided into five categories: benign, atypical/indeterminate, suspicious/probably malignant, malignant, and unsatisfactory, which then were compared with the CNB results. The cytological diagnoses of the 458 cases were as follows: 106 lesions (23.1%) were benign, 28 lesions (6.1%) were atypical/indeterminate, 42 lesions (9.2%) were suspicious/probably malignant, 88 lesions (19.2%) were malignant, and 194 lesions (42.4%) were unsatisfactory. The core wash cytology had a sensitivity of 89% (141 of 158), and a specificity of 72% (76 of 106). The CNB showed 143 of 194 unsatisfactory samples (74%) to be benign, three to be high-risk, and 48 (25%) to be malignant. Unsatisfactory samples were obtained from significantly more benign than malignant lesions. In conclusion, the high rate of insufficient samples for core wash cytology of breast lesions by US-guided CNB makes its use impractical in this setting. This technique is not useful for immediate diagnosis of breast lesions by US-guided CNB.     

超声引导下经皮空心针穿刺组织病理学检查对乳腺病灶的诊断效果评价

目的 探讨超声引导下经皮空心针穿刺(CNB)组织病理学检查诊断乳腺病灶的临床价值.方法 回顾性分析177例乳腺病灶的超声引导下CNB病理学检查结果 ,并与术后组织病理学诊断结果 进行比较,评价CNB诊断的效果.结果 177例乳腺病灶组织中,CNB病理诊断乳腺痛129例,术后病理组织学诊断乳腺癌136例,CNB病理诊断假阴性7例.CNB病理诊断乳腺癌的灵敏度为94.9%,特异度为100%,准确率为96.0%,阳性预测值为100%,阴性预测值为85.4%,约登指数为0.949,Kappa值为0.895(P<0.01).结论 CNB组织病理诊断乳腺病灶具有较高的准确性,与术后病理组织学诊断结果 一致性较高,是一种可靠的乳腺病灶活检方法 .     

Papillary breast lesions diagnosed by core biopsy require complete excision

Background

Surgical excision of papillary breast lesions with atypia diagnosed using core needle biopsy (CNB) has been accepted; however, the management of benign papillary lesions (without atypia) has been controversial. The purpose of this study was to evaluate the surgical outcome of nonmalignant papillary lesions diagnosed by ultrasound-guided 14-gauge CNB, and to establish clear guidelines on management of these lesions.

Methods

We retrospectively identified 268 nonmalignant papillary breast lesions, including 203 benign lesions and 65 atypical lesions, diagnosed by CNB and subsequently surgically excised in 250 women at our institution between July 2004 and October 2010. For each lesion, medical records and radiologic and pathologic reports were reviewed and coded. We compared the histological upgrade among the collected variables.

Results

On histological examination after surgical excision, 15.4% atypical papillary lesions and 5.9% benign lesions were upgraded to malignant, and 20.2% benign lesions were upgraded to atypical. Atypia (P = 0.015) was significantly associated with malignant upgrade at excision. No clinical or radiologic variable was helpful in predicting the possibility of histological upgrade of CNB-diagnosed nonmalignant papillary lesions.

Conclusions

Nonmalignant papillary lesions diagnosed with CNB showed an unacceptable pathological upgrade rate after excision. Therefore, surgical excision should be performed for all papillary lesions of the breast for definitive diagnosis.     

超声引导下空芯针穿刺小于1 cm的乳腺病变病理组织学诊断的效果评价

目的 探讨临床上不可触及且＜1 cm的乳腺病变经超声引导下空芯针穿刺活检（CNB）诊断的准确性。方法 回顾性分析2010年1月至2015年7月行CNB及手术切除的连续124例女性患者的临床病理资料。结果 CNB诊断乳腺癌29例,良性病变95例,其中29例乳腺癌和84例良性病变患者与手术病理的诊断一致,符合率为91.1％（113/124）,一致性检验的Kappa值为0.781（P＜0.001）。在CNB诊断为良性病变而手术确诊为乳腺癌的11例患者中,10例为组织学低估,1例为假阴性。结论 对于＜1 cm的乳腺病变进行超声引导下CNB诊断是简单且准确的方法。     

Evaluation and indications of ultrasound-guided vacuum-assisted core needle breast biopsy

BACKGROUND: The Mammotome is a diagnostic tool used under stereotactic or with ultrasound guidance. A clear indication for Mammotome use under stereotactic guidance is when a non-palpable microcalcification is a target. However, the indications for the use of the Mammotome under ultrasound guidance vary among institutions, and it is difficult to find a place for the Mammotome among conventional biopsy techniques. The Mammotome biopsy has been available in our hospital since July 1999. We assessed the effectiveness and indications of ultrasound-guided Mammotome biopsy. METHODS: We performed Mammotome biopsies in 433 cases requiring histological diagnosis from July 1999 to September 2006, using an 11-gauge articulated arm-type Mammotome under ultrasound guidance. There were 377 mass lesions including 83 non-palpable cases and 56 hypoechoic lesions. RESULTS: The indications for Mammotome biopsy were 162 cases with inconsistent fine needle aspiration (FNA) and imaging findings, 114 cases indeterminate by FNA, 68 cases of an identified pathological type before neoadjuvant chemotherapy and confirmation of hormone receptor status, 36 inadequate cases by FNA, 20 cases of confirmation of fibroadenoma and other benign tumors, 8 removal cases of fibroadenoma, 8 microcalcification cases, and 17 others. The target lesion was obtained in 99.5% of the cases. CONCLUSIONS: Ultrasound-guided Mammotome biopsy is an accurate and useful diagnostic method that enables sufficient amounts of tissue to be obtained with minimal invasion and few complications. The Mammotome is the first choice for obtaining a definitive pathological diagnosis in breast lesions.     

Present state of and problems with core needle biopsy for non-palpable breast lesions

The widespread use of screening mammography has resulted in increased detection of nonpalpable breast lesions here in Japan. For the histopathologic work-up of these lesions, stereotactic core biopsy is essential as a minimally invasive diagnostic procedure. However, the number of facilities that provide this procedure cannot keep up with the increasing demand from patients.Another issue is interpreting the results of the biopsy. With a histological diagnosis using needle samples, there is always a risk of underestimation or a false-negative result. To avoid missing cancers after stereotactic biopsy, it is important to check for sampling errors and for discrepancies between the radiologic and pathologic findings.We are pushing for the rapid spread of an ideal form of stereotactic breast core biopsy (using prone-type units, digital methods, and vacuum-assisted breast biopsy devices) throughout Japan so that every patient can undergo this examination.     

The management of papillary lesion of the breast by core needle biopsy

Background

The purpose of this study was to determine the accuracy of core needle biopsy (CNB) diagnoses of papillary breast lesions, and to identify the risk factors and histologic features, compared with excisional biopsy (EB).

Method

We retrospectively reviewed 1682 sonographically guided core needle biopsies performed at one single medical center from January 2001 through December 2005, and identified 41 papillary lesions. Surgical correlation was available for 35 cases, 2 cases were loss follow-up and 4 cases diagnosed as papilloma by core needle biopsy were followed up with imaging for at least 24 months.

Results

The pathologic diagnoses for the 35 papillary lesions obtained at core biopsy were benign in 24 cases, atypical in 7, and malignant in 4. Of those diagnosed as benign lesions at CNB, 7/24 turned out to be malignant. In the hyperplasia group, 5/7 were malignant. The total upgrade rate was 39%. The positive predict value was 100% and negative predict value was 61%.

Conclusion

All papillary lesions of the breast diagnosed by CNB should be excised because a substantial number of lesions were upgraded of diagnoses at excision.     

Follow-up of benign screen-detected breast lesions with suspicious preoperative needle biopsies

Aim

To study the outcome of patients with screen-detected breast lesions in whom preoperative core biopsy (CB), or fine needle aspiration cytology (FNAC), or both were suspicious of malignancy or malignant, but the final histology of the excised lesion was benign.

Materials and methods

Thirty-nine patients who fulfilled the above criteria were identified from a prospectively entered database of 192,153 breast screening examinations at the Bedfordshire and Hertfordshire Breast Screening Unit. Thirty-four patients had suspicious or malignant preoperative FNAC and/or CB, and five had FNAC only. Follow-up was mainly by mammograms. Outcome data were collected from hospital case notes and radiology reports.

Results

The median follow-up period was 3 years following excision biopsy. One patient whose excision biopsy histology was atypical ductal hyperplasia developed a mammographically occult carcinoma in the same breast after 24 months. There were no other cancers reported during this time.

Conclusion

The problem of suspicious preoperative needle biopsies with benign excision biopsy is uncommon in the breast screening population. These patients are not at an increased risk of being diagnosed with a carcinoma in the subsequent 3 years and may be discharged back to standard breast screening.     

Ultrasonographically guided 18-gauge automated core needle breast biopsy with post-fire needle position verification (PNPV)

BACKGROUND: Percutaneous imaging-guided core needle biopsy (CNB) is being used increasingly as an alternative to surgical biopsy for the diagnosis of breast lesions that are suspicious or highly suggestive of malignancy. The purpose of this study was to evaluate ultrasonographically (US) guided 18-gauge automated CNB with post-fire needle position verification (PNPV) in the assessment of US visible breast lesions. METHODS: Biopsy of 235 US visible breast lesions was performed using US-guided 18-gauge core needles (18-GCN). After firing the biopsy needle, an image was obtained in the orthogonal plane to confirm the precise post-fire position of the needle track before removing the needle. Needle core diagnoses were compared with surgical diagnoses in 235 lesions subsequently surgically excised. RESULTS: The median size of the lesions was 14 mm (range, 5-60 mm). Agreement between needle core and surgical diagnoses in the 235 lesions was 92% including 192 cancers, 28 benign lesions, and 3 high-risk lesions. In the remaining 12 discordant lesions, 4 were high-risk lesions and 8 were benign lesions. In all 8 benign lesions, imaging-histological discordance was present. The sensitivity of US guided 18-GCNB for breast cancer was 96% (199 of 207). In 71% (167/235) of the cases only one core with PNPV was made. No complications occurred. CONCLUSION: US-guided 18-GCNB for sonographically-demonstrated discrete mass lesions with PNPV is an accurate core needle biopsy technique of breast cancer. During the course of tissue sampling, evaluating the post-fire needle tip position by obtaining an orthogonal view with ultrasonographic guidance is the key to predicting the yield regardless of the size of the needle or the number of core samples.     

Core needle biopsy (CNB) as a diagnostic method for breast lesions: Comparison with fine needle aspiration cytology (FNA)

In Japan, fine needle aspiration biopsy (FNA) of the breast has long been recognized as a useful diagnostic tool, and has been used in many institutions because it provides a rapid, accurate and cost-effective evaluation. However, the use of core needle biopsy (CNB) is increasing, and vacuum assisted biopsy devices have been developed to produce larger specimens for analysis. CNB is useful because the frequency of inadequate specimens is lower than in FNA, and it requires a less invasive procedure than open biopsy. CNB is also more widely used, compared to FNA, because it can provide a more definitive diagnosis of borderline lesions and can be used to distinguish between IDC and ILC. Therefore, the use of CNB with mammographic or ultrasonographic guidance is especially high for non-palpable tumors. FNA is a rapid and non-invasive procedure that is useful for mass lesions. The accuracy of FNA for non-palpable lesions is relatively low, and depends upon the skill of the aspirators, cytoscreeners and cytopathologists involved in the procedure. However, FNA for palpable masses, coupled with a physical and mammographic examination (the so-called triple test) is highly accurate for diagnosis of breast cancer when all three modalities indicate malignancy, and for a benign lesion when all three are negative.     

Borderline breast core needle histology: predictive values for malignancy in lesions of uncertain malignant potential (B3)

Breast core needle biopsy (CNB) is an accurate test but may result in borderline histology (lesions of uncertain malignant potential or B3). This is an evaluation of the largest series (to date) of B3 histology, which focuses on estimating positive predictive values (PPV) for malignancy. We identified all B3 CNBs over a 10-year period in a single institution (N=372) from a series of 4035 consecutive needle biopsies. We describe the imaging findings, and report excision histology outcomes (N=279) and category-specific PPV for B3 lesions using two approaches including estimates based on subjects who had either excision or follow-up (N=328). B3 represented 9.2% of all CNB results. Excision histology was benign in 181 (64.9%) and malignant in 98 (35.1%) subjects (61 ductal carcinoma in situ, 37 invasive carcinoma). Positive predictive value for malignancy (based on excision histology) was 35.1% (95% CI: 29.5-40.7) and PPV (based on excision or review) was 29.9% (95% CI: 24.9-34.8). Lesion-specific PPV (estimates in parentheses for excision or follow-up) was atypical ductal hyperplasia 44.7% (40.6%); lobular intraepithelial neoplasia 60.9% (58.3%); papillary lesion 22.7% (15.9%); radial scar 16.7% (12.3%); phyllodes tumour 12.5% (12.5%); and B3 not specified 20.0%. Approximately one-third of CNB results classified as B3 are malignant on excision, and the likelihood of malignancy varies substantially between specific lesion groups. Whereas cases may be selectively managed without surgery, the majority warrant excision biopsy based on our estimates. Research is needed to improve differentiation between malignant and benign diseases in B3 lesions using diagnostic or predictive methods.     

超声引导下空芯针穿刺活检诊断的乳腺导管原位癌病理学低估的危险因素分析

背景与目的：由于存在病理学低估,乳腺导管原位癌（ductal carcinoma in situ,DCIS）是否需要行腋窝前哨淋巴结活检（sentinel lymph node biopsy,SLNB）仍有争议。通过回顾性分析,探索超声引导下空芯针穿刺活检（core needle biopsy,CNB）诊断的DCIS出现病理学低估的危险因素,探讨穿刺病理学诊断为单纯DCIS的患者免除腋窝SLNB的可能性。方法：选取2005年3月—2014年10月北京大学肿瘤医院暨北京市肿瘤防治研究所乳腺癌预防治疗中心收治的符合以下条件的乳腺癌病例纳入研究：女性;超声引导下CNB诊断为乳腺DCIS（含微浸润）;腋窝淋巴结临床阴性;接受规范的手术、放疗或全身系统性治疗。统计患者的临床病理学特征,采用χ ² 检验或Fisher精确概率法进行临床病理学特征与病理学低估比例的相关性分析,采用logistic回归探索病理学低估可能的危险因素。结果：研究纳入单纯DCIS、DCIS伴微浸润和DCIS可疑微浸润分别360、63和31例。单纯DCIS术后病理未升级占56.4%,升级为微浸润癌和浸润癌分别为21.7%和21.9%;后两组术后病理学诊断为微浸润癌的比例为30.2%和35.5%,浸润癌的比例为66.7%和61.3%,组间差异有统计学意义（P<0.001）。肿瘤＞3 cm和核分级高发生病理学低估的风险,分别是肿瘤≤3 cm和核分级中低的1.97倍（95% CI：1.17~3.32,P=0.011）和2.30倍（95% CI：1.34~3.98,P=0.003）,而人表皮生长因子受体2（human epidemal growth factor receptor 2,HER2）不确定（OR=0.37,95% CI：0.19~0.72,P=0.003）和阳性（OR=0.38,95% CI：0.20~0.73,P=0.004）发生病理学低估的风险低于HER2阴性,差异有统计学意义。肿瘤>3 cm、核分级高、HER2阳性的CNB单纯原位癌的病理学低估比例最高,为73.1%;肿瘤>3 cm、核分级高、HER2不确定的病理学低估比例最低,为11.9%。结论：超声引导下CNB诊断的DCIS伴微浸润或DCIS可疑微浸润病理学低估的比例远高于单纯DCIS,二者不能免除SLNB。肿瘤＞3 cm、核分级高和HER2阴性是术前单纯DCIS出现病理学低估可能的危险因素,单纯DCIS仍需行腋窝SLNB。     

The significance of minimally invasive core needle biopsy and immunohistochemistry analysis in 235 cases with breast lesions

OBJECTIVE To evaluate core needle biopsy （CNB） as a minimally invasive method to examine breast lesions and discuss the clinical significance of subsequent immunohistochemistry （IHC） analysis. METHODS The clinical data and pathological results of 235 patients with breast lesions, who received CNB before surgery, were analyzed and compared. Based on the results of CNB done before surgery; 87 out of 204 patients diagnosed as invasive carcinoma were subjected to immunodetection for p53, c-erbB-2, ER and PR. The morphological change of cancer tissues in response to chemo- therapy was also evaluated. RESULTS In total of 235 cases receiving CNB examination, 204 were diagnosed as invasive carcinoma, reaching a 100% consistent rate with the surgical diagnosis. Sixty percent of the cases diagnosed as non-invasive carcinoma by CNB was identified to have the presence of invading elements in surgical specimens, and similarly, 50% of the cases diagnosed as atypical ductal hyperplasia by CNB was confirmed to be carcinoma by the subsequent result of excision biopsy. There was no significant difference between the CNB biopsy and regular surgical samples in positive rate of immunohistochemistry analysis （p53, c-erbB-2, ER and PR; P 〉 0.05）. However, there was significant difference in the expression rate of p53 and c-erbB-2 between the cases with and without morphological change in response to chemotherapy （P 〈 0.05）. In most cases with p53 and c-erbB-2 positive, there was no obvious morphological change after chemotherapy. CONCLUSION CNB is a cost-effective diagnostic method with minimal invasion for breast lesions, although it still has some limitations. Immunodetection on CNB tissue is expected to have great significance in clinical applications.     

Factors predictive of breast cancer in open biopsy in cases with atypical ductal hyperplasia diagnosed by ultrasound-guided core needle biopsy

Aims

The purpose of the study was to explore factors predictive of breast cancer as diagnosed by excision biopsy in cases with a diagnosis of atypical ductal hyperplasia (ADH) on ultrasound-guided core needle biopsy (CNB).

Patients and methods

We carried out diagnosis of breast lesions by ultrasound-guided CNB in a single hospital in Taiwan from November 2003 to October 2009. Patients who were diagnosed with ADH and subsequently underwent excision biopsy were included in this study (n = 124).

Results

Fifty-six of the 124 patients who were included (45.2%) had cancer, and the remaining 68 had benign lesions. By multivariate analysis of all clinical characteristics and on the basis of the imaging features in these cases, older patient age (≥50 y/o, OR: 3.910, p = 0.005), larger tumour size (≥15 mm, OR: 3.398, p = 0.013), and the presence of architectural distortion by mammography (OR: 10.7, p = 0.036) were found likely to be associated with breast cancer.

Conclusions

Open biopsy is necessary in patients who were diagnosed with ADH on CNB. Older patients (≥50 y/o), with a larger tumour size (≥15 mm) and an abnormal mammography are especially likely to have breast cancer.     

Screen-detected malignant breast lesions diagnosed following benign (B2) or normal (B1) needle core biopsy diagnoses

Breast needle core biopsy (NCB) is now a standard diagnostic procedure in the triple assessment of screen detected breast lesions. However, unlike fine needle aspiration (FNA) cytology, information on the miss rate including false-negative diagnoses (FN) of malignancy (benign ‘B2’ or normal ‘B1’ NCB with a malignant outcome) is limited.MethodsA large series of NCBs (121, 742) performed over an 8-year period has been studied to assess the frequency and causes of missing a malignant diagnosis on NCB and to evaluate their impact on patients’ management in the screening service.ResultsDuring the period of this study, 50,691 were diagnosed as B2 and 9599 were diagnosed as B1. Of those, 779 B2 and 919 B1 were diagnosed as malignant on the subsequent surgical specimens, respectively, giving a FN rate of 3.0%. However when year of diagnosis was taken into consideration, we found that during the period 1999–2001, the FN rate for B2 was 2.7% while the miss rate for B1 was 4.0%. This showed marked improvement over time to reach a figure of 0.5% and 0.5% for B2 and B1, respectively, during the period 2005–2007. On detailed review of cases from a single screening region diagnosed during the last 3 years (2005–2008), 14 cases (0.17% of all NCBs) with malignant surgery were diagnosed as B2 (seven cases; FN rate 0.19%) and B1 (seven cases; B1 biopsy rate from cancer 0.19%). In these cases, NCB was unsatisfactory, there was a discrepancy between radiological abnormalities and histological findings with recommendation for excision or suspicious/malignant cytological diagnosis on concurrent FNA material. Therefore, our results indicate that the malignancy miss rate on NCB is rare and FN NCB diagnoses had no impact on patient management.     

Granular cell tumor of the breast diagnosed by core needle biopsy: a case report

Granular cell tumor rarely occurs in the breast. We report a 69-year-old woman with a right breast mass that simulated carcinoma on palpation, mammography, and ultrasonography. Aspiration biopsy cytology showed no malignant atypical cells. Core needle biopsy was performed to obtain an accurate diagnosis. The lesion was histologically confirmed to be a granular cell tumor. Immunostaining was positive for S-100 protein and vimentin, and negative for keratin, carcinoembryonic antigen, estrogen receptor and gross cystic disease fluid protein-15. The tumor was treated by wide local excision. Surgeons should be aware that granular cell tumor can resemble breast cancer in order to avoid performing a needless radical mastectomy.     

Risk of needle tract seeding of breast cancer: cytological results derived from core wash material

Needle track seeding has been recognized as a possible, albeit rare, complication of breast core needle biopsy. The purpose of this study was to assess the risk of needle tract seeding of breast cancer from cytological results derived from core needle wash material. The study included biopsies of 207 breast cancers performed using ultrasonographically guided 18-gauge core needles. Each core needle without exposed sample notch was washed in saline solution immediately after removing the needles. Cytology derived from core wash material was performed by saline solution lavage of the fragments using a cytocentrifuge. The cytological diagnoses were divided into five categories: benign, atypical/indeterminate, suspicious/probably malignant, malignant and unsatisfactory. Atypical/indeterminate, suspicious/probably malignant and malignant categories were considered to represent positive cases of needle track seeding of breast cancer, whereas benign and unsatisfactory categories were counted as negative cases. Cytological diagnoses of the 207 lesions were as follows: 26 lesions (12%) were benign, 18 lesions (9%) were atypical/indeterminate, 37 lesions (18%) were suspicious/probably malignant, 79 lesions (38%) were malignant, and 47 lesions (23%) were unsatisfactory. The incidence of positive cases of cytology derived from core wash material was 65% (134/207). The 25% frequency of positive cases of invasive lobular carcinoma was significantly lower than the frequencies of DCIS (74%) and invasive ductal carcinoma (69%) (P = 0.001 and P < 0.01). The frequency of positive cases in the multiple passes group was 75%, which was slightly, although not significantly, higher than the 66% frequency in the single pass group (P = 0.3). In conclusion, the incidence of positive cases of cytology derived from ultrasonographically guided breast core needles' wash material was 65%. The clinical significance is debatable; however, there may be a theoretical risk of local recurrence if the tract is not excised or radiotherapy not given.     

超声引导下经皮空心针穿刺组织病理学检查对乳腺病灶的诊断效果评价

目的 探讨超声引导下经皮空心针穿刺(CNB)组织病理学检查诊断乳腺病灶的临床价值.方法 回顾性分析177例乳腺病灶的超声引导下CNB病理学检查结果 ,并与术后组织病理学诊断结果 进行比较,评价CNB诊断的效果.结果 177例乳腺病灶组织中,CNB病理诊断乳腺痛129例,术后病理组织学诊断乳腺癌136例,CNB病理诊断假阴性7例.CNB病理诊断乳腺癌的灵敏度为94.9%,特异度为100%,准确率为96.0%,阳性预测值为100%,阴性预测值为85.4%,约登指数为0.949,Kappa值为0.895(P<0.01).结论 CNB组织病理诊断乳腺病灶具有较高的准确性,与术后病理组织学诊断结果 一致性较高,是一种可靠的乳腺病灶活检方法 .