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- What is the initial procedure in palpable brest lesions
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I heard that open biopsy is the initial prodecure for breast palpable breast mass lesions in most of our hospitals. Can you write down the initial or first procedure used for these women in your hospitals?
A. Fine needle aspiration biopsy
B. Core needle biopsy
C. Open biopsy
Hospitals in China
In most situation or in most cases.
Also what is the initial procedure for most non-palpable breast lesions.
Palpable lesions: one of A, B, C
Non-palpable lesions:one of A, B, C.
Thanks,
cz
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本帖最后由 于 2009-01-13 21:20:00 编辑
×参考诊断
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本帖最后由 于 2009-01-19 12:29:00 编辑
| 以下是引用天山望月在2009-1-17 14:27:00的发言：
谢谢赵老师！对粗细针穿刺的优缺点阐释的清晰明了。 想请教：细针穿刺一般不引起恶性肿瘤的转移（未见文献报道），粗针会不会引起转移呢？粗针穿刺要签知情同意书吗？乳腺粗针穿刺确诊率是多少？ |
1. The chance of metastesis by FNA and core bx is rare. It should not been considered as a risk factor.
2. Both FNA and core biopsy need patients to sign the content in the US.
3 Core bx accuracy
•Guided by False Negative
•Palpation 0-13%
•Ultrasound 0-12%
•Stereotactic 0.2-8.9%
• Dillon M et al. Annual of Surgery 242;5:701-707
In fact the accuracy of FNA is good as core biopsy. The main issue depends on sampling and level of interpretation. I am a breast/gynecologic surgical pathologist and cytopathologist. If do not consider the patients' suffer, cost et al, I would like to read core bx specimens. It is more easy to read breast core than breast FNA cytology. If we still do open biopsy with frozen for breast mass lesions, it is too old and too cost method.
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本帖最后由 于 2009-01-14 11:58:00 编辑
To answer 月新's questions:
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Overall, both FNAB and CNB can provide excellent opportunity to avoid unnecessary open biopsies.
opportunity to avoid unnecessary open biopsies.
•No single procedure is good for everyone.
•Goal must be to choose the right procedure for every patient who puts her trust in our hands.
•Should consider the cost, patients' comfort (physical and psychological).
(physical and psychological).
FNA advantages:
•Cost effective, Economic value
•Less pain
•Speed and psychosocial value
•Reliable and accurate
•Flexibility in various clinical settings
Flexibility in various clinical settings
•Integral part of any mass breast screening program
Integral part of any mass breast screening program
Reduction in the surgical excision rate in benign breast disease
FNA disadvantage
Difficult to separate DCIS from invasive cancer
-False positive and false negative
-Inability to make a diagnosis of papillary lesion
-Cannot identify lymph-vascular invasion
Advantage of core needle biopsy:
are the above disadvantage of FNA even though the sensitivity and specifity are similar.
In addition, FNA interpretaion needs well trained cytopathologists. CNB is relative easy to interpretate.
Good in non-palpable breast mass
Disadvantage of Core biopsy
More expensive than FNA
More tranmatic for patients
Longer time
–Possibility of seeding the biopsy tract?
Open biopsy should not be used as the initial procedure in most breast lesions even though it may be used in most hospitals in China. It is too bad. Open biopsy with fozen was used as initial procedure for breast mass 30 years ago in the US.
I have not any intention to discuss this topic here. But I have to based on the requirement of Dr. 月新. However there is few persons in China who responsed my requirment.
I am preparing a related talk now. I may give you a presentaion in future if you
want to.
