摘要目的 通过分析细针穿刺细胞学和空芯针穿刺活检组织学检查的准确性、不良反应和卫生经济学指标,探讨两种活检方法在高度可疑乳腺肿物术前诊断中的价值.方法 回顾性分析北京大学人民医院2012-2014年超声高度可疑恶性、未接受新辅助治疗且有后续手术病理的穿刺活检病例,比较细针穿刺和空芯针穿刺诊断的敏感度、特异度、阳性预测值、阴性预测值、假阳性率、假阴性率和不能确诊比例,以及穿刺操作的并发症、操作时间、病理结果等待时间及经济成本等指标.结果 共纳入细针穿刺病例273例,空芯针穿刺病例365例.两种方法准确率、敏感度、特异度、阳性预测值、假阳性率、假阴性率差异均无统计学意义(均P＞0.05).细针穿刺细胞学不能确诊率显著高于空芯针穿刺组织学检测(25.3％比10.9％,x2=22.59,P=0.000).细针穿刺操作时间短于空芯针穿刺(4.8±1.3 min比15.5±1.7 min,t=85.8,P=0.000),细针活检结果等待时间短于空芯针穿刺(1d比3d).两组均无严重并发症,细针穿刺皮肤瘀斑及血肿发生数低于空芯针穿刺.估算细针细胞学检查成本为447.5元/例,空芯针穿刺活检成本为995元/例.结论 细针穿刺和空芯针穿刺均是准确、安全的术前诊断手段.细针穿刺细胞学诊断具有操作简便、花费少的优点,不应低估其在乳腺癌术前诊断中的作用.

abstractsObjective To evaluate the value of fine needle aspiration (FNA) and core needle biopsy (CNB) in highly suspicious breast malignant lesions in terms of diagnostic accuracy,complication rate and cost-effectiveness.Methods We retrospectively reviewed records of patients with imaging diagnosis of BI-RADS 4c or 5 categories who have undergone either FNA or CNB under ultrasound guidance in Peking University People's Hospital from 2012 to 2014.Sensitivity,specificity,diagnostic accuracy,positive predictive,negative predictive,false positive rate,false negative rate,accuracy rate and unsatisfactory rate (non-diagnostic rate) were calculated and compared between FNAC and CNB.The complication of the procedures,operation time and cost were assessed.Results Among 638 consecutive cases,273 of them underwent FNA,and 365 underwent CNB.The accuracy rate of FNA and CNB were 99％ and 97.2％.The sensitivity,specificity,diagnostic accuracy,positive predictive,false positive rate and false negative rate were similar between the two groups.The unsatisfactory rate of FNA was significantly higher than that of CNB (25.3％ vs.10.9％,x2 =22.59,P =0.000).There was not severe complication in either groups,while subcutaneous ecchymosis and hematoma were more common in FNA group than in CNB group.The operation time of FNA was shorter than that of CNB (4.8 ± 1.3 min vs.15.5-± 1.7 min,P =0.000).The waiting time for final pathological report was shorter in patients undergoing FNA (1 vs.3 days).An estimated cost for FNA was RMB 447.5 Yuan/case,whereas that was 995 Yuan/case for CNB.Conclusions FNA and CNB are both accurate and safe preoperative diagnostic procedures.FNA is a simple and cost-effective method.