細針抽吸活組織檢查在乳腺保健診所中作用的適當評價

背景：在美國，乳腺保健診所（BHC）對細針抽吸活檢（FNA）來說是一個并不常見的資源，因此需要適當性評價。本研究介紹了一個為期2年的對乳腺細針抽吸活組織檢查適當性評價的經驗、出現(xiàn)的問題以及解決這些問題的方法。方法：評價病理學家、BHC供應者和其他的臨床醫(yī)生對FNA的不滿意率和核心活檢的比率，并對兩個不同時期的結果作以比較。這兩個時期的適當性標準都要求細胞學檢測結果和臨床以及乳腺影像結果的相關性，不要求識別出具體數(shù)目的導管上皮細胞。結果：在第一階段，BHC所做的乳腺FNA中有25%得到了不適當?shù)脑u價，而由病理學家和其他臨床醫(yī)生所做的分別為6%和14%。BHC的適當率超過國家癌癥研究所（NCI）推薦的上限20%，接受附加FNAB培訓后并沒有減少。在第一階段，24%的核心活檢收到不滿意的適當評價。在第二階段，核心活檢的體積增加，有12%收到不滿意的適當評價。結論：采用非細胞特點如臨床和影像檢測結果作為細針抽吸活組織檢查的適當標準是合適的，而不應以發(fā)現(xiàn)少量導管上皮細胞作為標準。但是NCI推薦的乳腺FNA不滿意上限20%并不適用于乳腺保健診所，因為這種操作中的損傷會導致不合適樣本的增加，引起對于質量的不必要關注。作者建議收到大量臨床醫(yī)生做的社區(qū)人群（尤其是BHC）FNA的實驗室應確定他們自己的不滿意閾值，超過此值時他們會調查技術或其他問題。

PMID:15386313

Cancer.2004Aug31;102（5）:295-301

Adequacyevaluationoffine-needleairationbioyinthebreasthealthclinicsetting.

HowellLP,Gandour-EdwardsR,FolkiK,DavisR,YasmeenS,AfifyA.

DepartmentofPathology,UniversityofCalifornia,DavisMedicalCenter,Sacramento,California.

BACKGROUND:Breasthealthclinics（BHC）areanunfamiliarsourceoffine-needleairationbioies（FNA）intheU.S.andcreatechallengesforadequacyevaluation.ThecurrentstudydescribedtheexperiencewithbreastFNABadequacyevaluationovera2-yearperiod,theiuesthatemerged,andtheproblem-solvingemployedtomitigatetheseiues.METHODS:TherateofuatisfactoryFNAandcorebioieswasdeterminedforpathologists,BHCproviders,andothercliniciaandcomparedfortwodifferentperiods.Adequacycriteriaduringbothperiodsrequiredcorrelationofthecytologicfindingswiththeclinicalandbreastimagingfindings,anddidnotrequireidentificationofaecificnumberofductalepithelialcells.RESULTS:Duringthefirsttimeperiod,25%ofbreastFNAperformedintheBHCreceivedaninadequateevaluationversus6%performedbypathologistsand14%performedbyotherclinicia.TheBHCadequacyrateexceededthe20%uerthresholdrecommendedbytheNationalCancerItitute（NCI）,anddidnotdecreaseafteradditionalFNABtraining.Duringthefirsttimeperiod,24%ofcorebioiesreceivedanadequacyevaluationofuatisfactory.Duringthesecondtimeinterval,thecorebioyvolumeincreasedand12%receivedanuatisfactoryadequacyevaluation.CONCLUSIO:ItisaropriatetousenoncellularfeaturessuchasclinicalandimagingfindingsasadequacycriteriaforbreastFNAratherthanidentificationofaminimalnumberofductalepithelialcells.However,the20%uerthresholdforuatisfactorybreastFNArecommendedbytheNCIwasnotaropriatefortheBHCsettingbecausethenatureofthelesioseeninthistypeofpracticecanleadtoanincreaseininadequateecimeandcauseuecearyconcernregardingquality.Theauthorsrecommendedthatlaboratoriesreceivingalargenumberofclinician-performedFNAfromacommunitypopulation,eeciallyaBHC,definetheirownuatisfactorythresholdabovewhichtheywillinvestigatefortechnical

PMID:15386313

背景：在美國，乳腺保健診所（BHC）對細針抽吸活檢（FNA）來說是一個并不常見的資源，因此需要適當性評價。本研究介紹了一個為期2年的對乳腺細針抽吸活組織檢查適當性評價的經驗、出現(xiàn)的問題以及解決這些問題的方法。方法：評價病理學家、BHC供應者和其他的臨床醫(yī)生對FNA的不滿意率和核心活檢的比率，并對兩個不同時期的結果作以比較。這兩個時期的適當性標準都要求細胞學檢測結果和臨床以及乳腺影像結果的相關性，不要求識別出具體數(shù)目的導管上皮細胞。結果：在第一階段，BHC所做的乳腺FNA中有25%得到了不適當?shù)脑u價，而由病理學家和其他臨床醫(yī)生所做的分別為6%和14%。BHC的適當率超過國家癌癥研究所（NCI）推薦的上限20%，接受附加FNAB培訓后并沒有減少。在第一階段，24%的核心活檢收到不滿意的適當評價。在第二階段，核心活檢的體積增加，有12%收到不滿意的適當評價。結論：采用非細胞特點如臨床和影像檢測結果作為細針抽吸活組織檢查的適當標準是合適的，而不應以發(fā)現(xiàn)少量導管上皮細胞作為標準。但是NCI推薦的乳腺FNA不滿意上限20%并不適用于乳腺保健診所，因為這種操作中的損傷會導致不合適樣本的增加，引起對于質量的不必要關注。作者建議收到大量臨床醫(yī)生做的社區(qū)人群（尤其是BHC）FNA的實驗室應確定他們自己的不滿意閾值，超過此值時他們會調查技術或其他問題。

PMID:15386313

Cancer.2004Aug31;102（5）:295-301

Adequacyevaluationoffine-needleairationbioyinthebreasthealthclinicsetting.

HowellLP,Gandour-EdwardsR,FolkiK,DavisR,YasmeenS,AfifyA.

DepartmentofPathology,UniversityofCalifornia,DavisMedicalCenter,Sacramento,California.

BACKGROUND:Breasthealthclinics（BHC）areanunfamiliarsourceoffine-needleairationbioies（FNA）intheU.S.andcreatechallengesforadequacyevaluation.ThecurrentstudydescribedtheexperiencewithbreastFNABadequacyevaluationovera2-yearperiod,theiuesthatemerged,andtheproblem-solvingemployedtomitigatetheseiues.METHODS:TherateofuatisfactoryFNAandcorebioieswasdeterminedforpathologists,BHCproviders,andothercliniciaandcomparedfortwodifferentperiods.Adequacycriteriaduringbothperiodsrequiredcorrelationofthecytologicfindingswiththeclinicalandbreastimagingfindings,anddidnotrequireidentificationofaecificnumberofductalepithelialcells.RESULTS:Duringthefirsttimeperiod,25%ofbreastFNAperformedintheBHCreceivedaninadequateevaluationversus6%performedbypathologistsand14%performedbyotherclinicia.TheBHCadequacyrateexceededthe20%uerthresholdrecommendedbytheNationalCancerItitute（NCI）,anddidnotdecreaseafteradditionalFNABtraining.Duringthefirsttimeperiod,24%ofcorebioiesreceivedanadequacyevaluationofuatisfactory.Duringthesecondtimeinterval,thecorebioyvolumeincreasedand12%receivedanuatisfactoryadequacyevaluation.CONCLUSIO:ItisaropriatetousenoncellularfeaturessuchasclinicalandimagingfindingsasadequacycriteriaforbreastFNAratherthanidentificationofaminimalnumberofductalepithelialcells.However,the20%uerthresholdforuatisfactorybreastFNArecommendedbytheNCIwasnotaropriatefortheBHCsettingbecausethenatureofthelesioseeninthistypeofpracticecanleadtoanincreaseininadequateecimeandcauseuecearyconcernregardingquality.Theauthorsrecommendedthatlaboratoriesreceivingalargenumberofclinician-performedFNAfromacommunitypopulation,eeciallyaBHC,definetheirownuatisfactorythresholdabovewhichtheywillinvestigatefortechnical