乳癌术前细针针吸细胞学选择性替代切除活检的指征探讨

INDICATION OF FNA REPLACING EXCIXION BIOPSY FOR DIAGNOSING BREAST CANCER

目的 探讨术前应用细针针吸细胞学替代术中切除活检的指征。方法 手术治疗118例“乳房肿块”病人,术前均行临床触诊及细针针吸细胞学检查,观察诊断的灵敏度和阳性预测值。结果 细针针吸细胞学检诊乳癌灵敏度为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％。结论 对于往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;若针吸涂片又查到癌细胞,则可免除术中切除活检并可据此进行术前化疗。

objective At present, most operable breast cancers are confirmed by excision biopsy during the operation. If the breast cancer was definitely diagnosed by Fine -Needle Aspiration cytology(FNA) preoperatively, the excision biopsy could be avoid. Methods We diagnosed 118 inpatients of breast mass with physical examination and FNA from September, 1995 to May, 1996. Results The sensitivity and positive predict value of FNA for diagnosing breast cancer are 95.7% and 97.1%. When the palpation and FNA are both positive, the doublepositive predict value for breast cancer is 100% in our study. It is the indication of using FNA that a breast mass was diagnosed as cancer by physical examination. We can treat a breast mass with redical operation directly without excision biopsy, if the breast mass was confirmed as breast cancer by both physical examination and FNA. Conclusion We concluded that the preoperative FNA could partially replace the excision biopsy for confirming breast cancer.