乳癌术前细针针吸细胞学替代术中切除活检的指征探讨

Indication of FNAC Replacing Excision Biopsy for Diagnosis of Breast Cancer

为探讨乳癌术前细针针吸细胞学选择性替代术中切除活检的可能性，对１９９５年９月～１９９６年５月间住院手术治疗的１１８例“乳房肿块”病人均行了术前临床触诊及细针针吸细胞学检查。结果显示：１１８例病人病理证实为乳癌者６９例。细针针吸细胞学检查诊断乳癌灵敏度为９５．７％，阳性预测值为９７．１％。当触诊与细针针吸均阳性时，其联合诊断乳癌的灵敏度仅为４７．８％，但联合阳性预测值却达到１００％。提示：对于住院接受手术的乳腺肿块病人，如果术前触诊能基本肯定为乳癌，则应行细针针吸细胞学检查；若针吸涂片查到癌细胞。

To study the possibility of Fine Needle Aspiration Cytology (FNAC) replacing excision biopsy for diagnosis breast cancer. From September 1995 to May 1996, we checked 118 patients with breast mass by physical examination and FNAC. The results showed that 69 patients were proved to be breast cancer by pathology in this series. The sensitivity and positive predict value of FNAC for diagnosis breast cancer were 95.7% and 97.1% respectively. When the palpation and FNAC were both positive, the “double” positive predict value for breast cancer was 100%, even though the sensitivity was just 47.8%. The results suggest that it is the indication of using FNAC that a breast mass was diagnosed as cancer by physical examination. A “breast mass” can be treated with radical operation directly without excision biopsy, if the breast mass was confirmed as breast cancer by both physical examination and FNAC.