细针穿刺联合细胞块技术在乳腺肿块诊断中的应用

Application of fine needle aspiration cytology combined with cell block technique in the diagnosis of breast masses

目的 探讨细针穿刺联合细胞块技术在乳腺肿块诊断中的应用价值。方法 回顾首都医科大学附属友谊医院473例乳腺细针穿刺病例,其中有165例同时制作了细胞块,与粗针活检和/或术后病理检查结果进行对比分析。结果 细针穿刺敏感性92.7%(319/344),特异性99.2%(128/129),准确率94.5%(447/473)。165例细胞块中明确分型诊断的符合率94.2%(97/103)。细针穿刺诊断纤维上皮性肿瘤的准确率为79.7%(55/69)。细针穿刺诊断乳腺浸润性癌符合率94.3%(66/70),细针穿刺联合细胞块及免疫组化诊断符合率97.2%(104/107)。细针穿刺细胞块与组织学免疫组化结果对比,ER、PR、HER2、P63和Ki-67的符合率分别为97.5%(155/159)、95.6%(152/159)、71.1%(106/149)、97.2%(138/142)和79.7%(126/158)。结论 细胞块技术可以弥补细针穿刺检查的不足,同时还可进行免疫组织化学染色等辅助检测,进一步提升细针穿刺检查的准确性和实用性。

Objective To investigate the application value of fine needle aspiration cytology(FNAC) combined with cell block technique in the diagnosis of breast masses. Methods A total of 473 cases of breast fine needle aspiration in our hospital were reviewed, and 165 cases of them had cell block made at the same time, and compared with the results of coarse needle biopsy and/or postoperative pathological examination. Results The sensitivity, specificity and accuracy of FNAC were 92.7%(319/344), 99.2%(128/129) and 94.5%(447/473), respectively. The coincidence rate of definite typing in 165 cell blocks was 94.2%(97/103). The accuracy of FNAC in the diagnosis of fibroepithelial tumor was 79.7%(55/69). The coincidence rate of fine needle aspiration in the diagnosis of invasive breast cancer was 94.3%(66/70), and that of fine needle aspiration combined with cell block and immunohistochemistry was 97.2%(104/107). Compared with FNAC plus cell block and histological immunohistochemical results, the coincidence rates of ER, PR, HER-2, p63 and Ki67 were 97.5%(155/159), 95.6%(152/159), 71.1%(106/149), 97.2%(138/142) and 79.7%(126/158), respectively. Conclusion Cell block technique can make up for the deficiency of FNAC, and it can also be used for auxiliary detection such as immunohistochemical staining, so as to further improve the accuracy and practicability of FNAC.