探讨空芯针穿刺活组织检查(CNB)在乳腺占位性病变诊断中的准确性及其临床价值。

回顾性分析2012年1月至2016年12月陆军军医大学西南医院乳腺外科收治的691例乳腺占位性病变患者的临床资料。全部患者均行术前CNB及手术治疗，对比CNB与术后病理结果。以术后病理诊断结果为金标准，评估CNB的敏感度和特异度，采用Kappa检验分析CNB与术后病理诊断的一致性。采用χ²检验比较CNB对高危病变与DCIS的低估率。

CNB与术后病理诊断的一致率为96.0%(663/691)，假阴性率为4.9%(28/571)，敏感度为95.1%(543/571)，特异度为100%(120/120)，阳性预测值为100%(543/543)，阴性预测值为81.1%(120/148)，约登指数为0.951，两者一致性较高(Kappa＝0.871，P<0.001)。CNB对DCIS、高危病变的低估率分别是27.8%(15/54)、45.0%(18/40)，两者差异没有统计学意义(χ²＝2.992，P＝0.084)。691例患者经手术确诊为乳腺叶状肿瘤有17例，而术前CNB诊断为叶状肿瘤有3例。另外，44.4%(16/36)的不典型导管增生患者经术后确诊后为恶性肿瘤。

CNB诊断乳腺占位性病变的准确性较高，但也存在假阴性和组织学低估的情况，必要时需要手术切除活组织检查明确诊断。

To investigate the accuracy and clinical value of core-needle biopsy (CNB) in the diagnosis of breast space-occupying lesions.

We retrospectively analyzed the clinical data of 691 patients with breast space-occupying lesions in the Department of Breast Surgery, Southwest Hospital, Army Medical University from January 2012 to December 2016. All patients underwent preoperative CNB and surgical treatment. The preoperative CNB results were compared with postoperative pathological results. With the postoperative pathological result as the gold standard, the sensitivity and specificity of CNB were evaluated. Kappa test was used to analyze the consistency of CNB with postoperative pathology. χ² test was used to compare the underestimation rates of high-risk lesions and ductal carcinoma in situ by CNB.

The coincidence rate between CNB and postoperative pathological result was 96.0% (663/691), the false negative rate 4.9% (28/571), the sensitivity 95.1%(543/571), the specificity 100%(120/120), the positive predictive value 100%(543/543), the negative predictive value 81.1%(120/148) and the Yoden index 0.951, indicating a high consistency (Kappa=0.871, P<0.001). The underestimation rates of CNB on ductal carcinoma in situ and high-risk lesions were 27.8% (15/54) and 45.0% (18/40), respectively. There was no significant difference between two groups (χ²=2.992, P=0.084). In all patients, 17 patients were diagnosed with lobular tumor by surgery, and among them, three patients had the accurate diagnosis by preoperative CNB. Additionally, 44.4% (16/36) of patients with atypical ductal hyperplasia were diagnosed with malignant tumor after surgery.

CNB has a high accuracy in the diagnosis of breast space-occupying lesions, but there are false negative cases and histological underestimates. If necessary, a surgical resection biopsy is recommended for a definitive diagnosis.