我想在此请教一些乳腺细针穿刺标本的问题，我曾经在中国跟赵博士学过这方面的知识，赵在今年广州中国细胞学会议上做了精彩的专题讲座。我有以下几个问题：1.有谁熟悉 "Triple test of Breast"? 2) 首次通过细针穿刺的病人确诊的多吗，有多大估计意义? 3) What are the common senerios breast FNA was ordered by the clinicians in China; 4)如果穿刺报癌，临床医生会怎么处理？请参与讨论，谢谢。

 1、考虑为乳腺癌（至于是小叶癌，还是导管癌，细胞学分类容易出错，结合6幅图，只是倾向于小叶癌可能性要大点）。

2、乳腺肿块细针吸取细胞学，如果肯定报告乳腺癌，完全没必要再做术中快速。我们是完全接纳阚秀教授的观点，乳腺癌的细胞学报告是分两种情况报告给临床的，一是肯定乳腺癌（细胞异型性明显且细胞量足够肯定诊断）的就报“乳腺癌”；另一种情况就是考虑为乳腺癌（通常是细胞异型性不明显，即使细胞量丰富、排列特殊，包括大多数小叶癌，高分化小细胞型的导管癌等），就报“考虑为乳腺癌，请结合术中快速切片进一步确诊”。在实际工作中，我们的临床医生都是如此执行的，所以我们报告的“乳腺癌”必须绝对准确。

 Thank you flyaqmt for the translation. Also, thank you xb3263 for the good and knowledgble response. In the US, breast 细针穿刺 for primary diagnosis is getting less and less, it is commonly replaced by breast 粗针穿刺。 Breast frozen sections are very rare because 粗针穿刺 most often gives definitive diagnosis and frozen of breast lesions can be very difficult and misleading. However, breast 细针穿刺 is still used for rule out or rule in recurrent breast cancer and the materials can be collected to make cell blocks to do ER, PR, and Her2 studies even FISH (we do that in our hospital).

 The basic concept of what is breast 细针穿刺 and waht size of the needle qualifies breast 细针穿刺 is still debatable? The most accepted concept is that any needle larger than 21G (内直径0.5 mm) is considered 粗针穿刺.

坏死物   考虑结核

但乳腺结核 少见

这次细胞成分很多，细胞比较单一，核大小不等。倾向肿瘤，需排除癌。

 This will be an intetresting case to discuss breast FNA in general. The first 3 photos are not very cellular, in contrast, the last 3 photos are very cellular and the cells are discohesive, also show some pleomorphism, it is very worrysome for malignancy. Again, sorry for the staining comment, I think this is a H&E stain again, it is kind of fusy and not crystal clear (good Pap stain usually does a better job).

 I would like to bring the issue of breast FNA. I learned some of the status of Breast FNA in China from Dr. CZhao, who gave an excellent lecture on that topic in this year's Chinese Cytology Meeting in Guangzhou.

I am still curious to know the following aspects: 1) Are anyone familiar with the "Triple test of Breast"? 2) How common is a breast lesion or mass evaluted by FNA first? 3) What are the common senerios breast FNA was ordered by the clinicians in China; 4)If you call a breast FNA positive for carcinoma, what the surgeon will do in China? Please partipate in the discussion. Thanks!