细针吸取细胞学检查对乳腺良性病变的鉴别诊断

Fine needle aspiration cytology in the differential diagnosis of breast benign diseases

目的 :探讨鉴别纤维囊性乳腺病和乳腺纤维腺瘤细针吸取细胞学 (FNAC)的主要细胞形态学指标。方法 :运用Logistic多重回归模型的统计分析方法 ,对 2 2 4例有活检证实的乳腺FNAC的良性病变 (4 8例纤维囊性乳腺病和 176例纤维腺瘤 )的5 4个细胞学指标进行分析 ,指标的评价采用 0～ 3+的分级评价方式。结果 :研究发现 ,最有价值的鉴别指标是细胞量 (P =0 0 0 1) ,次要指标是背景的游离肌上皮细胞量 (P <0 0 5 )。组合细胞量 (2～ 3+)和背景的游离肌上皮细胞量 (2～ 3+)作为联合指标进行评价 ,可将纤维腺瘤的阳性预测价值提高至 93 5 %。结果发现 ,在乳腺FNAC检查中 ,分叶结节状的间质在纤维囊性乳腺病和乳腺纤维腺瘤中的发生率存在明显的差异性。结论 :在乳腺细针吸取细胞学的良性病变中 ,细胞量和背景的游离肌上皮细胞量是鉴别纤维囊性乳腺病和纤维腺瘤的最有价值的细胞形态学指标。分叶结节状的间质是管内型纤维腺瘤的间质的组织形态在FNAC中的表现 ,是诊断纤维腺瘤的特征性指标 。

Purpose To identify primary criteria of the fine needle aspiration cytology(FNAC) for the differential diagnosis between fibroadenoma and fibrocystic disease of the breast. Methods Two hundred and twenty four cases of FNAC of breast benign diseases(48 fibrocystic disease and 176 fibroadenoma) which had a follow-up operation and a histopathologic diagnosis as the final diagnosis were reviewed and analyzed by a step-wise logistic regression. All cases were coded of 54 cytologic variables with score ranging from 0 to 3+ assigned to each characters. Step-wise logistic regression analyses were performed to determine the variables predictive of fibrocystic disease or fibroademoma. Results The statistical analyses selected cellularity (P=0.001) as the primary diagnostic criteria and isolated myoepithelial cells on the background (P<0.05) as the secondary criteria. The combined presence of both criterias (cellularity(2～3+) and isolated myoepithelial cells(2～3+)) can improve the positive predictive value of fibroadenoma even further to 93.5%. Also find that the lobulated nodular stroma reaches a significant difference between fibroadenoma and fibrocystic disease of the breast in FNAC. Conclusions When an aspirate from a breast lesion is cytologically benign, cellularity and isolated myoepithelial cells on the background can be the most significant cytologic criterias to differentiate fibrocystic disease from fibroadenoma. Lobulated nodular stroma in FNAC is the morphologic manifestation in cytopathology of the nodular stroma in fibroadenoma with intracanalicular growth pattern in histopathology, and is the characteristic cytologic feature for fibroadenoma.