乳腺肿物超声引导粗针活检组织学诊断准确性探讨

目的探讨乳腺肿物超声引导粗针活检(CNB)病理组织学诊断的准确性及其影响因素.方法结合临床资料,对72例乳腺穿刺活检标本和开放性活检标本的病理组织学诊断进行比较和分析.结果临床送检的72例乳腺CNB标本的病理组织学诊断分别为:浸润性癌43例,原位癌/非典型增生3例,良性病变20例,未见明显病变6例.CNB与开放性活检的病理诊断符合率为90%,kappa＝0.798(P＜0.01).乳腺恶性病变CNB病理诊断的敏感性为92%,特异性为100%.CNB漏诊原因分别为临床取材失误2例,病理诊断3例,临床处理不当1例.CNB诊断较困难的病变主要是原位癌、早期浸润性导管癌和浸润性小叶癌.结论超声引导下粗针活检是一种敏感性高和特异性很强的乳腺病变诊断方法,对少数特殊类型乳腺病变的诊断存在着一定的局限性.

Evaluation of Histological Diagnostic Accuracy with Ultrasound-guided Core Needle Breast Biopsy

Objective To investigate the accuracy of the histological diagnosis of ultrasound guided coreneedle breast biopsy(CNB) and to find out the factors influencing the diagnosis.Methods Data were collected retrospectively for 72 ultrasound guided CNB that were followed by open biopsy (OB) The principal histological findings obtained at CNB and OB were identified for each procedure and the degree of agreement was assessed.Results Of seventy two lesions,CNB identified invasive breast carcinoma in forty three,atypical ductal carcinoma in situ (DCIS) in three,benign in twenty and nonspecific in six The principle histology identified at CNB was confirmed at OB for 90% of the lesions,generating a kappa value of 0 798( P <0 01) The sensitivity for malignancy with CNB was 92% and the specificity was 100% The reasons for cancers missed by CNB included clinical sampling error in 2 cases,histological underdiagnosis for 3 cases and inadequate management strategy for 1 case There were some difficulties with CNB in the diagnosis of DCIS,early invasive ductal carcinoma and infiltrative lobular carcinoma.Conclusions Ultrasound guided coreneedle breast biopsy is a sensitive,as well as a high specific diagnostic method,except for a few special kinds of breast diseases