ﺑﺮرﺳﻲ دﻗﺖ ﺗﺸﺨﻴﺼﻲ آﺳﭙﻴﺮاﺳﻴﻮن ﺑﺎ ﺳﻮزن ﻇﺮﻳﻒ در 128 ﻣﻮرد ﺗﻮدة ﻗﺎﺑﻞ ﻟﻤﺲ ﭘﺴﺘﺎن در ﻣﺮاﻛﺰ درﻣﺎﻧﻲ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ اﻳﺮان ﻃﻲ ﺳﺎل ﻫﺎي 1384 ﺗﺎ 1387

Accuracy of Fine Needle Aspiration in 128 Cases Palpable Breast Masses in Medical Centers of Iran University of Medical Sciences during 2005-2008

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺍﻣﺮﻭﺯﻩ ﻳﻜﻲ ﺍﺯ ﺷﺎﻳﻌﺘﺮﻳﻦ ﻣﺴﺎﺋﻞ ﺟﺮﺍﺣﻲ ﺩﺭ ﺯﻧﺎﻥ ﺗﻮﺩﻩ ﻫﺎﻱ ﭘﺴﺘﺎﻥ ﻣﻲ ﺑﺎﺷﺪ. ﺑﻴﻮﭘﺴﻲ ﺟﺮﺍﺣﻲ ﺍﺳﺘﺎﻧﺪﺍﺭﺩ ﻃﻼﺋﻲ ﺟﻬﺖ ﺗﺸﺨﻴﺺ ﺗﻮﺩﻩ ﻫﺎﻱ ﻗﺎﺑﻞ ﻟﻤﺲ ﭘﺴﺘﺎﻥ ﻣﺤﺴﻮﺏ ﻣﻲ ﮔﺮﺩﺩ. ﺩﺭ ﺣﺎﻝ ﺣﺎﺿﺮ ﺗﺄﮐﻴﺪ ﺑﺮ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺭﻭﺵ ﻫﺎﻱ ﺗﺸﺨﻴﺼﻲ ﻣﻄﻤﺌﻦ ﭘﻴﺶ ﺍﺯ ﺟﺮﺍﺣﻲ ﺍﺳﺖ. ﺩﺭ ﮐﺸﻮﺭﻫﺎﻱ ﭘﻴﺸﺮﻓﺘﻪ، ﺁﺳﭙﻴﺮﺍﺳﻴﻮﻥ ﺑﺎ ﺳﻮﺯﻥ ﻇﺮﻳﻒ Fine Needle Aspiration (FNA)][ ﺑﻪ ﻋﻨﻮﺍﻥ ﻳﮏ ﺍﺑﺰﺍﺭ ﻣﻬﻢ ﺩﺭ ﺍﺭﺯﻳﺎﺑﻲ ﺗﻮﺩﻩ ﻫﺎﻱ ﭘﺴﺘﺎﻥ ﺑﮑﺎﺭ ﮔﺮﻓﺘﻪ ﺷﺪﻩ ﺍﺳﺖ. ﻫﺪﻑ ﻣﺎ ﺩﺭ ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﺗﻌﻴﻴﻦ ﺩﻗﺖ ﺁﺳﭙﻴﺮﺍﺳﻴﻮﻥ ﺑﺎ ﺳﻮﺯﻥ ﻇﺮﻳﻒ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﺗﻮﺩﻩ ﻫﺎﻱ ﻗﺎﺑﻞ ﻟﻤﺲ ﭘﺴﺘﺎﻥ ﺑﻮﺩﻩ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﺍﻳﻦ ﺗﺤﻘﻴﻖ ﮐﺎﺭﺑﺮﺩ ﺑﺎﻟﻴﻨﻲ ﻭ ﺩﻗﺖ ﺗﺸﺨﻴﺼﻲ ﺁﺳﭙﻴﺮﺍﺳﻴﻮﻥ ﺑﺎ ﺳﻮﺯﻥ ﻇﺮﻳﻒ ﺩﺭ 128 ﺑﻴﻤﺎﺭ ﻣﺒﺘﻼ ﺑﻪ ﺗﻮﺩﻩ ﻗﺎﺑﻞ ﻟﻤﺲ ﭘﺴﺘﺎﻥ ﺑﺮﺭﺳﻲ ﮔﺮﺩﻳﺪ. ﮐﻠﻴﻪ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺯ ﺩﺭﻣﺎﻧﮕﺎﻩ ﻫﺎﻱ ﺩﻭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺩﺍﻧﺸﮕﺎﻫﻲ ﺩﺭ ﺷﻬﺮ ﺗﻬﺮﺍﻥ ﻃﻲ ﺳﺎﻝ ﻫﺎﻱ 1384 ﺗﺎ 1387 ﺟﻤﻊ ﺁﻭﺭﻱ ﺷﺪﻧﺪ. ﺟﻮﺍﺏ ﺁﺳﭙﻴﺮﺍﺳﻴﻮﻥ ﺑﺎ ﺳﻮﺯﻥ ﻇﺮﻳﻒ ﺑﺮ ﺍﺳﺎﺱ ﺁﺧﺮﻳﻦ ﻃﺒﻘﻪ ﺑﻨﺪﻱ ﺳﻴﺘﻮﭘﺎﺗﻮﻟﻮﮊﻱ ﺑﻪ 5 ﮔﺮﻭﻩ ﺩﺳﺘﻪ ﺑﻨﺪﻱ ﺷﺪ،ﮐﻪ ﻋﺒﺎﺭﺕ ﺑﻮﺩﻧﺪ ﺍﺯ:C1 )ﻧﻤﻮﻧﻪ ﻧﺎﮐﺎﻓﻲ(، C2 ﺧﻮﺵ ﺧﻴﻢ(، C3 ﻭ C4 )ﺑﻴﻨﺎﺑﻴﻨﻲ( ﻭ ) C5ﺑﺪﺧﻴﻢ(. ﭘﺲ ﺍﺯ ﺟﻤﻊ ﺁﻭﺭﻱ ﺍﻃﻼﻋﺎﺕ ﻻﺯﻡ ﺗﺠﺰﻳﻪ ﻭ ﺗﺤﻠﻴﻞ ﺗﻮﺳﻂ ﻧﺮﻡ ﺍﻓﺰﺍﺭ ﺁﻣﺎﺭﻱ SPSS 15 ﺻﻮﺭﺕ ﮔﺮﻓﺖ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮ ﺭﻭﻱ 128 ﺑﻴﻤﺎﺭ ﺍﻧﺠﺎﻡ ﺷﺪ. ﺗﻌﺪﺍﺩ ﺯﻧﺎﻥ 118 ﻭ ﻣﺮﺩﺍﻥ 10 ﻧﻔﺮ ﺭﺍ ﺗﺸﮑﻴﻞ ﻣﻲ ﺩﺍﺩﻧﺪ. ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ﺟﻤﻌﻴﺖ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ 42±14 ﺳﺎﻝ ﺑﻮﺩ. ﻧﺘﻴﺠﻪ ﺍﻧﺠﺎﻡ ﺁﺳﭙﻴﺮﺍﺳﻴﻮﻥ ﺑﺎ ﺳﻮﺯﻥ ﻇﺮﻳﻒ ﻋﺒﺎﺭﺕ ﺑﻮﺩ ﺍﺯ: ﺩﺭ ﮔﺮﻭﻩ 46 C5 ﺑﻴﻤﺎﺭ ﺩﺭ 9 ﺑﻴﻤﺎﺭ ﺷﮏ ﺑﻪ ﺑﺪﺧﻴﻤﻲ )C4(، ﺿﺎﻳﻌﺎﺕ ﺧﻮﺵ ﺧﻴﻢ ) (C2ﺩﺭ 34 ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ ﻳﺎﻓﺖ ﺷﺪ ﻭ ﺁﺳﭙﻴﺮﺍﺳﻴﻮﻥ ﺑﺎ ﺳﻮﺯﻥ ﻇﺮﻳﻒ ﺩﺭ 2 ﺑﻴﻤﺎﺭ ﺑﺎ ﺗﻐﻴﻴﺮﺍﺕ ﺁﺗﻴﭙﻲ ﺑﻪ ﻧﻔﻊ ﺧﻮﺵ ﺧﻴﻤﻲ ﺭﺍ ﻧﺸﺎﻥ ﺩﺍﺩ(C3 . ﻧﻤﻮﻧﺔ ﻧﺎﮐﺎﻓﻲ )C1( ﺩﺭ 28 ﻣﻮﺭﺩ )22%( ﻭﺟﻮﺩ ﺩﺍﺷﺖ. ﺟﻮﺍﺏ ﭘﺎﺗﻮﻟﻮﮊﻱ ﺍﮐﺴﻴﺰﻳﻮﻥ ﺩﺭ 46 ﺧﻮﺵ ﺧﻴﻢ ﺑﻮﺩﻩ ﺍﺳﺖ. ﺁﺳﭙﻴﺮﺍﺳﻴﻮﻥ ﺑﺎ ﺳﻮﺯﻥ ﻇﺮﻳﻒ ﺗﻮﺍﻧﺴﺘﻪ ﺍﺳﺖ 45 ﺗﻮﺩﺓ ﺑﺪﺧﻴﻢ ﺭﺍ ﺑﺎ ﺣﺴﺎﺳﻴﺖ 91 ﺷﻨﺎﺳﺎﺋﻲ ﮐﻨﺪ. ﻭﻳﮋﮔﻲ ﺁﺳﭙﻴﺮﺍﺳﻴﻮﻥ ﺑﺎ ﺳﻮﺯﻥ ﻇﺮﻳﻒ ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ 97 ﻭ ﻣﺜﺒﺖ ﮐﺎﺫﺏ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ 3 ﻭ ﻣﻨﻔﻲ ﮐﺎﺫﺏ 9 ﺑﻮﺩﻩ ﺍﺳﺖ. ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﺜﺒﺖ 97 ﻭ ﺍﺭﺯﺵ ﺍﺧﺒﺎﺭﻱ ﻣﻨﻔﻲ 91 ﺑﺪﺳﺖ ﺁﻣﺪﻩ ﺍﺳﺖ.ﮐﻼﹰ ﺩﻗﺖ ﺁﺳﭙﻴﺮﺍﺳﻴﻮﻥ ﺑﺎ ﺳﻮﺯﻥ ﻇﺮﻳﻒ 94 ﻣﺤﺎﺳﺒﻪ ﺷﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺩﺭ ﻣﻮﺭﺩ ﺿﺎﻳﻌﺎﺕ ﺗﻮﭘﺮ ﻗﺎﺑﻞ ﻟﻤﺲ، ﺑﻴﻮﭘﺴﻲ ﺑﺎ ﺳﻮﺯﻥ ﻇﺮﻳﻒ ﺑﺎﻳﺴﺘﻲ ﻳﮏ ﻭﺳﻴﻠﺔ ﺗﺸﺨﻴﺼﻲ ﺍﻧﺘﺨﺎﺑﻲ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻧﻲ ﮐﻪ ﺗﻮﺩﻩ ﺍﺯ ﻧﻈﺮ ﺑﺎﻟﻴﻨﻲ ﺍﺣﺘﻤﺎﻻﹰ ﺧﻮﺵ ﺧﻴﻢ ﻭ ﻳﺎ ﺷﮏ ﺑﺎﻻﻱ ﺳﺮﻃﺎﻥ ﻭﺟﻮﺩ ﺩﺍﺭﺩ، ﻣﺪ ﻧﻈﺮ ﻗﺮﺍﺭ ﺩﺍﺩ. ﻫﻤﭽﻨﻴﻦ ﺭﻭﺵ ﺗﺸﺨﻴﺼﻲ ﻣﻨﺎﺳﺐ ﺩﺭ ﺩﻭﺭﺓ ﺑﻠﻮﻍ ﻭ ﺩﺭ ﺯﻧﺎﻥ ﺟﻮﺍﻥ ﺍﺳﺖ. ﺩﺭ ﻣﻮﺍﺭﺩﻱ ﮐﻪ ﺷﮏ ﺑﺎﻻﻱ ﺑﺪﺧﻴﻤﻲ ﻭﺟﻮﺩ ﺩﺍﺭﺩ، ﻧﺒﺎﻳﺪ ﺁﺳﭙﻴﺮﺍﺳﻴﻮﻥ ﺑﺎ ﺳﻮﺯﻥ ﻇﺮﻳﻒ ﻣﻨﻔﻲ ﻣﺎ ﺭﺍ ﺍﺯ ﺍﻧﺠﺎﻡ ﺍﮐﺴﻴﺰﻳﻮﻥ ﺑﺎﺯ ﻣﻨﺤﺮﻑ ﮐﻨﺪ. ﺁﺳﭙﻴﺮﺍﺳﻴﻮﻥ ﺑﺎ ﺳﻮﺯﻥ ﻇﺮﻳﻒ ﻣﻲ ﺗﻮﺍﻧﺪ ﻳﮏ ﺟﺎﻳﮕﺰﻳﻦ ﻗﺎﺑﻞ ﺍﻋﺘﻤﺎﺩ ﺑﺮﺍﻱ ﺑﻴﻮﭘﺴﻲ ﺍﮐﺴﻴﺰﻳﻮﻧﺎﻝ ﺩﺭ ﻃﺮﺡ ﺭﻳﺰﻱ ﺩﺭﻣﺎﻥ ﻗﺒﻞ ﺍﺯ ﺟﺮﺍﺣﻲ ﺑﺎﺷﺪ.

Introduction & Objective: Surgical biopsy of palpable breast lump was considered as the gold standard for the diagnosis of breast lump(s). Emphasis has been placed on improving methods for establishing a definitive diagnosis of breast masses prior to surgery. In developed countries breast fine-needle aspiration (FNA) has been increasingly an accepted as an important triage tool for the evaluation of breast lumps. In this research, our aim was to determine the diagnostic accuracy of fine needle aspiration cytology (FNAC) in patients with palpable breast masses Materials & Methods: During 2005-2008 we examined the clinical utility and the diagnostic accuracy of breast FNAB result by studying 128 breasts mass. Cases were collected from two large university- affiliated teaching hospitals and clinics. After FNAB, all the patients were subjected to excisional biopsy. The cytologic diagnoses were classified into five groups: C1(Inadequate), C2(Benign), C3 and C4(Intermedite), and C5(malignant). We analyzed the collected data by SPSS 15. Results: This study was performed on 128 patients. It involved 118 females and 10 male. The mean age was 42±14 years old. All patients underwent FNAB performed. Conclusive malignancy (C5) was found in 46(36%) patients and in 9 patients, malignancy was suspected (C4). Conclusive benign lesions (C2) were found in 34% patients and 2 patients had atypia i.e. (C3). Inadequate specimen (C1) was found in 28(22%) patients. On excision biopsy, 46%patients had malignant lumps and 53% were benign. FNAB was able to detect 45 malignant lumps, with sensitivity of 91%. Most of them were also reported malignant on excision biopsy, with specificity of 97%. False positive was 3% and false negative was 9%. PPV was 97% and NPV was 91%. Overall FNA accuracy was 94%. Conclusions: Fine needle aspiration biopsy of solid palpable breast lesions should be the diagnostic procedure of choice for those patients who are clinically classified as probably benign or clinically as highly suspicious for cancer. It can be the diagnostic modality choice in adolescent and young female. For highly suspicious cases, a negative fine needle aspiration should not deter an open surgical biopsy. For patients classified as Intermediate, fine needle aspiration biopsy results are not reliable enough to determine treatment. FNA is a reliable substitute for exicional biopsy for obtaining a definitive preoperative diagnosis.