乳腺钼靶立体定位在乳腺隐匿性病灶的临床应用

目的探讨乳腺X线立体定位在乳腺隐匿性病灶的诊断价值。方法回顾性总结87例临床未触及乳腺病变的患者应用X线定位核芯活检术或倒钩针标记活检术。结果87例患者中，85例成功，发现早期乳腺癌21例，重度非典型增生16例，乳腺小叶增生19例，乳腺纤维腺瘤20例，硬化性腺病9例。结论乳腺钼靶摄片立体定位是诊断乳腺隐匿性病灶的重要方法。     

Breast aspiration biopsy with multihole needles for histologic and cytologic examination

Multihole needle biopsy has been performed on 166 patients. Commercially available 22-, 20-, 18-, and 16-gauge hypodermic needles (40 to 75 mm in length) are prepared with three sharp-edged holes around the distal part of the needle, allowing aspiration of 3 to 6 ml or more of tissue, for both histologic and cytologic examination. Of patients with carcinoma, fibrocystic disease, fibroadenoma, intraductal proliferation (papillomatosis), and duct ectasia, multihole needle cytologic examination is significantly more accurate (35% to 83%) than single-hole needle examination (11% to 67%). Multihole needle histologic examination, however, is far more accurate, with diagnostic success ranging from 75% to 94% for the disorders described above. The procedure has several uses. For patients with isolated fibrocystic areas, duct ectasia, or papillomatosis, multihole needle biopsy not only is diagnostic but may also be therapeutic by virtue of removal of abnormal tissue by aspiration. Biopsies of areas of microcalcification can be obtained under x-ray control. In patients at high risk of breast cancer (carcinoma in mother and/or sister), breast aspiration is performed when the slightest suspicion arises. In patients with unilateral breast cancer at high risk of bilateral carcinoma (premenopausal breast cancer, lobular carcinoma, tubular carcinoma, family history of breast cancer), random needle biopsy is performed in the contralateral breast for cancer detection. Furthermore, during follow-up of breast cancer patients, biopsies of locoregional changes or suspicious areas in the contralateral breast are obtained with the multihole needle for diagnostic evaluation. Thus multihole needle biopsy represents an improvement over the single-hole needle currently used, with enough tissue provided for adequate initial diagnosis and follow-up diagnostic evaluations in patients with benign and malignant breast disease.     

Accuracy of mammographic appearances after breast fine-needle aspiration

OBJECTIVE: The objective of this study was to document the observation that fine-needle aspiration of palpable breast masses by use of a modified technique performed shortly before mammography need not adversely interfere with mammographic interpretation nor produce falsely suspicious mammographic lesions that delay meaningful evaluation and management in this breast clinic.STUDY DESIGN: In a retrospective record review 1007 women who were seen in the Breast Diagnostic Center at Women's and Children's Hospital from January 1992 until April 1995 and who had fine-needle aspiration of a palpable solid breast mass within 2 weeks before mammography were analyzed overall and in 10-year age group subsets. The mammographic reports of “suspicious” lesions were correlated with having had a prior fine-needle aspiration (within 2 weeks).RESULTS: Of the 1007 women undergoing fine-needle aspirations, 91 had a cytologic or tissue biopsy specimen diagnosis of malignancy. Of these, 72 had “suspicious” mammograms and 19 had “nonsuspicious” mammograms. The calculated positive predictive value was 58%. The negative predictive value was 98%. Mammographic sensitivity was 79%. Specificity was 94%. Age stratification did not reveal any meaningful trends. Of the 916 patients with benign cytologic results of fine-needle aspiration specimens, 52 had “suspicious” mammograms and 864 had “nonsuspicious” mammograms.CONCLUSION: For patient convenience and expeditious diagnosis of a palpable breast mass, fine-needle aspiration can be performed on the initial visit and mammograms subsequently taken within 2 weeks without undue clinical confusion or misleading mammographic findings. Concordance of the diagnostic triad consisting of (1) clinical impression (by history and examination), (2) fine-needle aspiration, and (3) mammography gives a reliable conclusion and can appropriately be used as the basis for clinical management of a breast mass. However, when there is doubt or anxiety about the diagnosis either on the part of the patient or the physician, a definitive histologic tissue diagnosis should obtained. (Am J Obstet Gynecol 1997;176:1286-92.)     

Fine needle aspiration for evaluation of breast masses

PURPOSE OF REVIEW: Fine needle aspiration has been used for many years as a diagnostic tool for breast lesions, with high sensitivity and specificity. There is controversy as to whether this technique should be replaced by other diagnostic procedures such as core biopsy. This review aims to re-evaluate the usefulness of breast fine needle aspiration. RECENT FINDINGS: During the past 10 years many institutions have replaced fine needle aspiration by core biopsy and related techniques such as vacuum-assisted core biopsy and advanced breast biopsy instrument action. Other institutions continue to use fine needle aspiration as a first line of investigation for breast lesions. This technique is especially useful in radiologically benign lesions and when combined with image guidance. The use of the 'triple test' (combined cytologic, clinical and radiologic findings) decreases false-negative and false-positive results. SUMMARY: Fine needle aspiration continues to be an acceptable and reliable procedure for the preoperative diagnosis of breast lesions, particularly in developing countries, and when used as part of the 'triple test'. Accurate diagnosis requires experience in both aspiration technique and specimen interpretation. Clinicians should be mindful of the limitations of the technique. The choice between fine needle aspiration and core biopsy should be individualized for the patient.     

Palpable abnormalities of the breast not requiring excisional biopsy.

The evaluation of a patient with a palpable abnormality of the breast typically includes physical examination, mammography and fine needle aspiration biopsy (FNAB) with cytologic interpretation of the aspirate. If the findings of these three diagnostic modalities are negative for malignancy, the current standard of care is to proceed to surgical biopsy to confirm the benign nature of the lesion. The current study was done to identify a subset of patients who could be safely observed without surgical (histologic) biopsy. These patients fulfilled specified criteria on physical examination, mammogram and needle sensation when the FNAB needle entered the lesion. Results of the cytologic studies of the FNAB were used as a corroborative rather than as a diagnostic test. Of 305 patients with mammary abnormalities, 106 were identified with "subsuspicious" lesions. Seven of the latter patients underwent surgical biopsy, four because the results of cytologic studies of FNAB revealed cytologic atypia. One of the four patients had infiltrating ductal carcinoma. All other patients have had follow-up evaluation for a mean of 61 months (range of 43 to 74 months). No carcinomas have developed at the subsuspicious site. The current study is the first to clearly define a subset of patients with palpable abnormalities of the breast who do not require surgical biopsy.     

Fine-needle biopsy of the breast in the material of Gynecology and Obstetrics Hospital in Walbrzych

OBJECTIVES: Since the year of 2000 we have done more than 500 fine-needle aspiration biopsies in our hospital. DESIGN: The main cause was a breast lesion interpreted as suspicion of cancer in ultrasonography or mammography and its verification between benign tumor and a cancer. MATERIALS AND METHODS: 508 women with clinical findings of breast tumor were qualified for fine-needle biopsy procedure. RESULTS: The most common diagnosis was a benign cystic tumor found in 183 cases and the second one--fibro-cystic mastopathy (132 cases). Surgical operation of the breast was performed in 32 cases. In 17 we found breast cancer and in 14 the diagnosis was suspicion of breast cancer. CONCLUSIONS: Fine-needle biopsy is valuable for diagnosis of breast cancer and can be easily learned and used by the clinician. It's safe, cost-effective, and accurate technique, which has no counter-indications and causes little discomfort. Results are available in a short time so the decision about the necessity for excisional biopsy or mastectomy is made quickly.     

Comparison of needle aspiration cytologic diagnosis with excisional biopsy tissue diagnosis of palpable tumors of the breast in a community hospital.

Fine needle aspiration cytologic examination has not extensively been used in our hospital in the work-up evaluation of solid tumors of the breast and its reliability as a basis on which to perform definitive treatment of carcinoma of the breast was in question. One hundred and five aspiration cytologic specimens were obtained from palpable solid tumors of the breast just prior to excisional biopsy. Specimens were numbered and submitted to three different staff pathologists for diagnosis in a single blind manner. Results were then compared with tissue diagnosis of the same tumors. Of 105 specimens taken at biopsy of the breast, 28 malignant lesions were diagnosed on the final tissue report. Of those, ten were diagnosed as malignant (Class V), two were highly suspicious (Class IV) and six were insufficient specimens (Class O). Of those diagnosed as class IV and V by the results of cytologic examination, all were malignant on permanent section for a specificity of 100 per cent and a sensitivity of 36 per cent. The cytologic diagnoses of Classes I, II and III did not correlate with any histologic report, benign or malignant. Malignant growths were misdiagnosed by cytologic examination in 36 per cent and missed because of inadequate specimens in 28 per cent. We believe that a Class V cytologic finding is sufficient basis on which to perform definitive treatment of carcinoma of the breast provided rigid criteria are used. There is a learning curve associated with this diagnostic modality.     

Needle aspiration cytologic examination in the management of suspicious lesions of the breast

The experience of one surgeon with needle aspiration cytologic examination used as an office procedure in the management of suspicious solid lesions of the breast over a period of seven years in presented. Three hundred and thirty-five aspirations were performed with the diagnosis of carcinoma subsequently established in 126 or 37 per cent of the patients. In 79 of these patients (63 per cent) carcinoma was diagnosed preoperatively by positive needle aspiration cytologic examination only. There were no false-positive results. Thus, this group of patients was spared time and added expense of open biopsy before definitive surgical treatment was instituted.     

Evaluation of computed tomography guided percutaneous biopsy of the pancreas

The results of 96 computed tomography guided percutaneous pancreatic aspiration biopsies were reviewed to evaluate the diagnostic sensitivity, specificity and accuracy in pancreatic mass lesions. These were assessed by comparing pathology results to findings at subsequent laparotomy, autopsy or to immediate and long term clinical findings. Effects of varying the size of the biopsy needle and the number of aspirations performed were examined. Of the primary tumors of the pancreas in which adequate material was obtained, 97.3 per cent were correctly diagnosed with one false-negative and no false-positive results. The over-all sensitivity rate for primary tumor so the pancreas was 71.9 per cent using a No. 22 gauge "skinny" needle and 86.7 per cent using a No. 20 gauge needle. Over-all diagnostic accuracy for all types of lesions was 61.8 per cent using a No. 22 gauge needle and 73.3 per cent using a No. 20 gauge needle. A No. 19 gauge needle with a sheath was used on lesions with fluid or necrotic debris when a pseudocyst was a possibility. Over-all diagnostic accuracy using a No. 19 gauge sheathed needle was 81.8 per cent on all types of lesions. There was no benefit in using two passes versus a single aspiration. There were no complications, regardless of the needle size or number of passes. The serum amylase level increased in one instance after biopsy and this returned to normal a few days after biopsy. Computed tomography guided aspirations are safe and effective in evaluation of focal or diffuse enlargements of the pancreas when proper techniques and appropriate precautions are used.     

The accuracy of malignant diagnoses established by fine needle aspiration cytologic procedures of mammary masses

Fine needle aspiration cytologic studies are being used with increasing frequency to diagnose carcinoma of the breast. To determine whether or not a diagnosis of carcinoma established by cytologic examination is sufficiently accurate to proceed to treatment without tissue confirmation, we have examined our results in a series of 109 patients who had 111 aspiration cytologic procedures followed by open biopsy between January 1985 and June 1987. From this group, 39 specimens were read as malignant and 19 were read as suspicious. Thirty-eight of 39 specimens with positive readings were from lesions that proved to be malignant on subsequent open biopsy. Seventeen of 19 suspicious specimens were also from malignant lesions. Three of 17 specimens that were inadequate and nine of 36 negative specimens were from lesions that were later shown to be malignant. Our single false-positive result occurred on cells that had been air dried during preparation in the early months of experience with this technique at our institution. Re-evaluated later in our series, the same specimen was called suspicious rather than malignant. We conclude that a positive reading on fine needle aspiration is highly accurate. The positive predictive value should be 100 per cent, once experience is gained in preparing and interpreting the material. Open biopsy is necessary for inadequate, negative or suspicious specimens to exclude a malignant lesion if the clinical or mammographic findings are consistent with carcinoma.     

The role of aspiration cytologic examination in the diagnosis of carcinoma of the breast

A study of 2,000 patients who had undergone fine needle aspiration of a solid lump of the breast was conducted to determine the accuracy of this technique. During the period 1982 to 1989, all patients with a solid mammary mass, presenting to a specialized breast unit were initially investigated by fine needle aspiration cytologic examination (FNAC). To date, we present data on 2,000 consecutive aspirations with matching histologic diagnosis on the excised pathologic specimens. In particular, the relationship between tumor histologic factors and the accuracy of cytologic diagnosis was examined. The sensitivity of FNAC in the diagnosis of a malignant growth was 84 per cent; this represents first aspiration results only. The specificity was more than 99 per cent. The rate of acellular or unsatisfactory aspirations was 12 per cent. We had a positive predictive rate for diagnosis in carcinoma of the breast of almost 95 per cent. The diagnosis of lobular and in situ patterns of disease was questioned, with three of three in situ lesions and ten of 23 lobular lesions missed by FNAC. We do not recommend that FNAC replace excision biopsy and frozen section in the diagnosis of carcinoma of the breast.     

Hand-held ultrasound-guided vacuum biopsy of mammary lesions--first experiences

OBJECTIVE: Evaluation of indications for ultrasound guided hand-held Mammotome-biopsy. MATERIAL AND METHODS: To achieve breast diagnosis 50 ultrasound guided hand-held Mammotome-biopsies were performed between January 3rd and April 4th, 2000. RESULTS: 34 patients presented with non-palpable, 16 with palpable breast lesions. The benign-to-malignant ratio was 80% to 20%. Complete removal of the lesion we established in 22 (44%) of all 50 procedures. Definitive breast diagnosis of malignancies was achieved in all but one case. CONCLUSIONS: We regard the ultrasound guided hand-held Mammotome-biopsy as diagnostic and surgical instrument that provides the clinician with a flexible and easy to use method of accurate breast diagnosis. Lesions too small, superficial, or deep for conventional core biopsy are indications for a ultrasound guided Mammotome-biopsy as well as abnormalities where wide sampling is considered important or small fibroadenomas. However, standard of care for breast diagnosis remains the conventional hand-held 14-gauge-core-biopsy. For malignant lesions hand held mammotomy must be regarded as a diagnostic and not a therapeutic procedure.     

Surgical diseases of the breast during pregnancy

Physicians caring for women with diseases of the breast are well aware of the time lost before many patients consult their physicians. Nowhere is this more apparent than when a breast mass is associated with gestation or lactation. Enlargement of the breast tends to obscure parenchymal masses. Those that are found are too readily attributed to normal hypertrophy, abscess, or resolving fibrocystic disease. In this review we have attempted to focus on the earlier diagnosis and treatment of breast masses in pregnancy. Prompt needle aspiration will elucidate the solid or cystic nature of a mass. A simple cyst or a galactocele can be diagnosed by the fluid obtained. Solid lesions can be further investigated by fine-needle aspiration for cytologic study. Cytologically equivocal lesions should be subjected to excisional biopsy using local anesthesia. Cancerous lesions occurring during pregnancy should be treated promptly by mastectomy. The outlook for these patients, if treated before metastases occur, is comparable to that for nonpregnant patients. Pregnancy need not be terminated unless disseminated cancer is present and chemotherapy is necessary on an urgent basis.     

The importance of fine needle aspiration biopsy and sonographic evaluation of parametria in cervical cancer

OBJECTIVE: The aim of study was to estimate of the value of fine needle aspiration biopsy (FNAB) and transvaginal ultrasonography (TVS) in the preoperative assessment of the parametria in cervical cancer. We compared parametrial infiltration before and postoperatively by histopathology to verified and confirmed staging of disease. Correct staging qualification, especially evaluation of the parametrium, is very useful in choosing an adequate method of treatment, and thereby in patient survival. MATERIAL AND METHOD: 52 women (median age 56 years, range 33-85) with cervical cancer in Stage Ib and 49 (median age 51, range 36-71) in Stage II and III, were included in the study. Assessment of parametrial invasion before treatment was performed by fine needle aspiration biopsy (FNAB) with endovaginal ultrasound assistance. The sonographic evaluation of parametria was performed by Siemens Sonoline Versa Pro with a transvaginal 7 MHz mechanical transducer with a biopsy guide and 21-gauge needle. The probe was covered with a disposable latex sheath filled with ultrasound gel. The aspirated material was placed on a glass slide, fixed in 95% alcohol and submitted to cytologic evaluation. All of the patients with cervical cancer in Stage Ib underwent a Wertheim-Meigs hysterectomy. The preoperative findings were compared with data obtained by histopathology findings. Moreover, in the whole group of 101 patients a comparison of FNAB and sonography was performed. The sensitivity, specificity and diagnostic accuracy of this method were evaluated. RESULTS: Parametrial involvement assessed postoperatively by histopathology, in clinical Stage Ib cervical cancer was found in eight of 52 cases (15.4%). FNAB of parametrial involvement in the operated group was accurate in 14 of 18 (accuracy--83%, sensitivity--78%, specificity--84%, PPV--50%, NPV--95%). Sonographic assessment of parametrial involvement was correct in 12 of 18 cases (accuracy--58%, sensitivity--67%, specificity--56%, PPV--24%, NPV--89%). In the whole group of patients (operated and non-operated), sonographic evaluation of parametria verified by FNAB was correct in 104 of 202 cases (accuracy--78%, sensitivity--71%, specificity--86%, PPV--84%, NPV--74%). CONCLUSIONS: FNAB and TVS assessment of the parametria are very useful methods in confirmation of neoplastic infiltration. Correct preoperative diagnosis may improve staging, treatment and indirectly, survival of patients with cervical cancer.     

Mammary ductoscopy for the evaluation of nipple discharge and comparison with standard diagnostic techniques

STUDY OBJECTIVE: To describe performance of breast duct endoscopy and compare the method with conventional diagnostic techniques. DESIGN: Canadian Task Force classification III. SETTING: Interdisciplinary Breast Unit of a university hospital. PATIENTS: Consecutive and unselected series of 15 female patients including 20 breasts with nipple discharge. INTERVENTIONS: Prospective data assessment on all patients with ductoscopy for nipple discharge between April 2003 to April 2004. All preoperative (mammography, ultrasonography, nipple smear) and minimally invasive (galactography, fine needle aspiration cytologic study) diagnostics were evaluated and compared with ductoscopy. MEASUREMENTS AND MAIN RESULTS: Mammography on 20 breasts showed BI-RADS-I (5%), BI-RADS-II (50%), and BI-RADS-III (45%). Breast ultrasound scanning showed abnormalities, classified as BI-RADS-III equivalent lesions in all cases. Nipple smear showed in 69.2% a normal cytology and in most cases revealed a papilloma later (n=8/9). Unilateral galactography was performed in 46.7% who had spontaneous nipple discharge. Two galactography results were unremarkable, and open biopsy demonstrated 1 atypical ductal hyperplasia and papilloma. On 20 breasts of 15 women, 19 ductoscopies were successfully performed (95%). In 17 cases open biopsy followed ductoscopy, and 1 ductal carcinoma in situ (DCIS), 3 atypical ductal hyperplasia (ADH), 1 ductal hyperplasia without atypias, and 12 ductal papillomas were found. CONCLUSION: Compared to nipple smear, the diagnostic value of ductoscopy in this study is superior but marginally inferior to galactography and highly specialized breast ultrasound scanning. Therefore ductoscopy needs to be evaluated on a larger scale, preferably in multicenter trials to further determine its potential and indications.     

Recurrent breast haematoma after fine needle aspiration biopsy of angiosarcoma

It is reported a rare complication after a fine needle aspiration biopsy of a breast angiosarcoma. A 30-years-old female presented with a right breast lump. An ovoid, hypoecoic lesion of 39 x 13 mm was detect by ultrasonography. A fine needle aspiration biopsy was carried out for diagnosis, but only blood was report. After the biopsy the skin showed a violaceous color, the lump was tender, reappeared in three instances and increased its size (15 cm). In spite of conservative management the pain and the mass did not disappear, then surgical management was decided. A soft, violaceous mass of 13 x 6 x 4 cm, with well demarcated boundaries was removed. A capillary and cavernous breast hemangioma was diagnosed. Four months later a recurrence presented, and a new excision was carried out with a resulting moderately differentiated angiosarcoma, then a simple mastectomy was performed for definitive treatment. On a literature search only one similar case was found. A recurrent haematoma after a fine needle aspiration biopsy of a breast tumor mandates to rule out an angiosarcoma.     

Stereotactic needle breast biopsy: a review of current status and practice

The early detection of breast cancer is a concern to women and their physicians. Although screening mammography can identify early breast lesions, many are small and non-palpable. In the past, open excisional biopsy often was required to establish the diagnosis. Recently, stereotactic breast biopsy, a minimally invasive technique, has permitted tissue diagnosis of small lesions without open surgery, with results comparable to those obtainable with excisional biopsy. We reviewed this technique, its application in identifying small breast lesions, and in diagnosing breast cancer in its early stages.     

Value of fine needle aspiration biopsy in cervical cancer

Correct staging qualification, especially evaluation of parametrium is very useful in choosing of adequate method of treatment, and thereby in patients' survival. OBJECTIVE: The aim of study was estimation of the value of fine needle aspiration biopsy in transvaginal ultrasonography assistant in preoperative assessment of parametria in cervical cancer. We compared parametrial infiltration before treatment and to verified and confirmed staging in cervical cancer postoperatively by histopathology. MATERIAL AND METHOD: 64 women with cervical cancer in stage Ib, were included in the study. Assessment of parametrial invasion before treatment was performed by fine needle aspiration biopsy in endovaginal ultrasound assistants. The sonographic evaluation of parametria was performed by Siemens Sonoline Versa Pro with transvaginal 7 MHz mechanical transducer with the biopsy guide 14 cm long. All of patients with cervical cancer in stage Ib were operated on Wertheim-Meigs hysterectomy. The preoperative findings were compared with data obtained by histopathology findings. There were evaluated sensitivity, specificity and diagnostic accuracy of this method. RESULTS: Accuracy of fine needle aspiration biopsy of parametrial involvement was 89%, sensitivity-70%, specificity-92.6%, PPV-63.6%, NPV-94.3%. CONCLUSIONS: Transvaginal ultrasonography is superior to routine clinical examination in the assessment of parametria. Sensitivity of fine needle biopsy with ultrasound assistance is higher then of gynecological examination and ultrasound alone. Correct preoperative diagnosis may improve staging, treatment and indirectly, survival patients with cervical cancer.     

Application of aspiration biopsy cytology in the diagnosis of breast diseases

Fine-needle aspiration biopsy of the breast was performed in 198 patients; 158 benign and 8 malignant lesions were found, 24 samples were considered unsatisfactory and 8 suspicious. The cytological diagnosis was correlated with clinical follow-up and histological findings. The Author discusses the value of aspiration biopsy cytology in the clinical assessment of breast disease and describes the cytological appearances and diagnostic criteria in the major benign and malignant breast diseases.     

Cytologic findings of aspiration of tumors of the breast

Fine needle aspiration biopsy for cytologic diagnosis has been shown to be an effective adjunct to the clinical evaluation of masses of the breast by physical examination and mammography. In addition to adequately decompressing cystic masses, the procedure has been beneficial in obtaining a pathologic interpretation of any mass that is to be observed. Preoperative knowledge of the malignant nature of a mass of the breast allows the physician to investigate more selectively the possibility of metastatic disease and to consider more intelligently treatment options. Furthermore, the psychologic agony of the unknown for the patient and her family is avoided. Although histologic confirmation is always recommended before proceeding with mastectomy, a positive cytologic diagnosis can suffice when clinically advanced carcinoma is present or when there are medical contraindications to surgical treatment. Because of the false-negative rate of aspiration cytologic diagnosis, all clinically malignant or suspicious masses should have a biopsy in the face of benign cytology. This point cannot be over emphasized and is particularly pertinent to those patients in whom high risk factors of carcinoma of the breast are present. Inconclusive aspirates should be repeated or a biopsy of the mass should be done.