乳腺核芯针穿刺病理诊断的准确性

目的 提高乳腺核芯针穿刺病理诊断的准确性.方法 回顾性观察解放军总医院病理科2004年1月至2007年6月667例超声引导下乳腺核芯针穿刺连续病例,主要以先行核芯针穿刺活检,随后切除病变的患者为研究对象,对比核芯针穿刺与手术切除标本的病理形态,分析诊断差异的原因.结果 382例核芯针穿刺后行局部病变切除、保乳手术和乳房切除术,切除手术后病理诊断为恶性者281例,其中假阴性4例,假阴性率为1.4%.无假阳性病例.低估者28例,导管原位癌低估者为6/11,高估者2例.核芯针穿刺诊断的准确率为94.7%(266/281).结论 了解乳腺核芯针穿刺取材的局限性,善用免疫组织化学指标,掌握少见病变,才能减少低估和高估病例、杜绝假阳性病例.病理医师应在保证诊断准确的前提下,尽可能细化诊断.

Study on diagnostic accuracy of ultrasound-guided core needle breast biopsy

Objective To evaluate the diagnostic accuracy of ultrasound-guided core needle biopsy of breast tumors. Methods Six hundred and sixty-seven cases of core needle biopsy of breast encountered during the period from January, 2004 to June, 2007 were retrieved from the archival file and retrospectively reviewed. The core needle biopsy diagnoses were correlated with the histologic findings of the subsequent surgical excision specimens. The discrepancies were further analyzed. Results Three hundred and eightytwo patients had core needle biopsy diagnosis followed by local excision, breast conservation surgery or mastectomy. Two hundred and eighty-one cases were confirmed to have malignancy in the surgical specimens. Review of the corresponding core needle biopsies showed 4 false-negative cases, no false-positive cases, 28 cases with underestimation and 2 cases with overestimation. The false-negative rate was 1.4% (4/281). The rate of underestimation for ductal carcinoma-in-situ was 6/11. The diagnostic accuracy of core needle biopsy was 94.7% (266/281). Conclusion In order to improve the diagnostic accuracy of core needle biopsy of breast tumors, recognition of the limitation of the procedure, application of immunohistochemistry and awareness of potentially rare entities are important.