核心针活检在乳腺病变诊断和乳腺癌新辅助化疗中的应用价值  

Core needle biopsy for the diagnosis of breast tumor

作　　者：张柏林[1] 徐晓洲[1] 杨迅[1] 郑闪[2] 王仲照[1] 吕宁[2] 王翔[1] 张保宁[1] 

机构地区：[1]中国医学科学院肿瘤医院腹部外科,北京100021 [2]中国医学科学院肿瘤医院病理科,北京100021

出　　处：《中华普通外科杂志》2009年第8期631-633,共3页Chinese Journal of General Surgery

基　　金：北京市科技计划课题（编号：D0905001040131）

摘　　要：目的评价核心针活检（core needle biopsy，CNB）诊断乳腺病变的准确率和浸润性乳腺癌化疗前、后雌激素受体（estrogen receptor，ER）、孕激素受体（progesterone receptor，PR）和Her2蛋白免疫组织化学（immunohistochemistry，IHC）检测结果的一致性。方法回顾性分析本院2005年6月至2008年4月间进行的516例CNB结果。结果本组所有资料均由两位病理医生独立进行病理学诊断。共诊断乳腺恶性肿瘤、原位癌和叶状肿瘤484例，灵敏度为96．7％。经手术活检证实的假阴性为16例（3．3％）。CNB诊断准确率不受病灶最大径影响（P=0．423）。接受化疗前、后IHC检测的乳腺癌ER、PR和Her2一致率分别为90．3％、76．8％和82．5％。结论CNB是准确、有效的检查方法。受乳腺癌的组织异质性和治疗的双重影响，化疗前后的ER、PR和Her2检测的一致性尚难获得满意结果。Objective To evaluate the accuracy of core needle biopsy （CNB） in diagnosing breast masses and its coherence with immunohistochemical （IHC） examination results of estrogen receptor （ER） , progesterone receptor （PR） and Her2 protein between pre- and post-chemotherapy in invasive breast cancer. Methods The results of 516 CNB cases from June, 2005 to April, 2008 were analyzed retrospectively. The pathological examination was performed by two pathologists independently. Results 484 cases of malignant tumor, carcinoma in situ and phyllodes tumor were found in this group with the sensitivity of 96. 7%. Sixteen cases of false negative （3.3%） were demonstrated by surgical biopsy. The accurate rate of CNB was not influenced by the maximum diameter of masses （ P = 0. 423 ）. The agreement rate of IHC results of ER, PgR and Her2 between pre- and post-chemotherapy were 90. 3% , 76. 8% and 82. 5% , respectively. Conclusion CNB is a useful diagnostic method with a satisfactory accuracy in any size of breast masses. Given the histological heterogeneity of invasive breast cancer and the influence of chemotherapy, the coherence of prechemotherapy IHC for ER, PgR and Her2 is not optimal with that of post-chemotherapy.

关 键 词：乳腺肿瘤 活组织检查 免疫组织化学 

分 类 号：R686[医药卫生—骨科学]