Diagnostic accuracy for different strategies of image-guided breast intervention in cases of nonpalpable breast lesions
Diagnostic accuracy for different strategies of image-guided breast intervention in cases of nonpalpable breast lesions
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DOI：
10.1038/sj.bjc.6601559
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发表时间：
2004-02-09
影响因子：
8.8
通讯作者：
Peeters, PHM
中科院分区：
文献类型：
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作者：
Pijnappel, RM;van den Donk, M;Peeters, PHM
为了查明超声引导细针抽吸（FNA）以及超声和立体定向引导大芯针活检（LCNB）是否是日常实践中针定位开放乳腺活检（NLBB）的可靠替代方案，我们进行了一项回顾性研究并评估了这些方法的有效性。总共纳入了来自荷兰三家医院的 718 名患有 749 个不可触及的乳腺病变的女性，并对各种诊断方法的有效性进行了评估。这是根据伯班克和帕克描述的用于评估图像引导乳房干预质量的方法进行的。我们将我们的结果与 COBRA 研究的结果进行了比较。总体而言，所有诊断策略（NLBB、FNA、LCNB 超声和立体定向引导）均显示出相当的一致性。然而，漏检率有所不同：NLBB 为 2%，COBRA（研究环境中的 LCNB）为 3%，FNA 为 5%，实践中 LCNB 为 8-12%。 29% 的患者通过细针抽吸无法得出结论，而 9% 的患者则高估了 DCIS。 NLBB 中的 DCIS 低估率为 8%。为了评估仅由微钙化组成的病变并排除所有其他病变中的恶性肿瘤，应使用 14 号针。超声引导下的干预可用于大部分不可触及的病变。乳房X光检查中仅由微钙化组成的病变需要特别注意。
To find out whether ultrasound-guided fine-needle aspiration (FNA) and ultrasound and stereotactic-guided large core needle biopsy (LCNB) are reliable alternatives to needle-localised open breast biopsy (NLBB) in daily practice, we performed a retrospective study and evaluated the validity of these methods. In all, 718 women with 749 nonpalpable breast lesions from three Dutch Hospitals were included, and the validity of the various methods for diagnosis was assessed. This was carried out according to a method described by Burbank and Parker for evaluating the quality of an image-guided breast intervention. We compared our results with the outcome of the COBRA study. Overall, all diagnostic strategies (NLBB, FNA, LCNB ultrasound and stereotactic guided) show comparable agreement rates. However, the miss rates differ: 2% for NLBB, 3% for COBRA (LCNB in study setting), 5% for FNA and 8-12% for LCNB in practice. Fine-needle aspiration was nonconclusive in 29%, and shows an overestimation for DCIS in 9%. The DCIS underestimate rate in NLBB was 8%. For the assessment of lesions consisting of microcalcifications only and to exclude malignancy in all other lesions, a 14-gauge needle should be used. Ultrasound-guided intervention can be performed in a large percentage of nonpalpable lesions. Lesions consisting only of microcalcifications on mammography need special attention.