CAJ | 학술논문

目的总结乳腺癌细针穿刺的细胞形态学特点及鉴别诊断.方法观察175例乳腺癌细针穿刺的细胞学涂片与76例乳腺增生症、93例乳腺纤维腺瘤对照分析;同时观察20例细胞学漏诊和低诊乳腺癌细胞学涂片与13例细胞学过诊病例对照分析.结果 175例乳腺癌:细胞排列杂乱无极性96.6%(169/175),核间疏松排列71.4%(125/175),以散在或小细胞群为主34.3%(60/175),核中等大小以上81.1%(142/175),圆形细胞核占绝大多数88.6%(155/175),核边缘不整齐28.6%(50/175),核质比明显增大60%(105/175)、明显减小8.6%(15/175),大核仁28%(49/175),核大小差异明显77.7%(136/175),未见肌上皮细胞96%(168/175),可见坏死13.7%(24/175),散在细胞圆形核占绝大多数89.7%(157/175)、胞质完整66.9%(117/175),均明显高于乳腺增生症、乳腺纤维腺瘤的相对病例数,差异均有统计学意义(P<0.05);细胞数量多的、散在细胞中等量以上的分别为52.6%(92/175)、55.4%(97/175),均明显高于乳腺增生症的5.3%(4/76)、14.5%(11/76),均P<0.05.20例细胞学漏诊、低诊乳腺癌:圆形核细胞占绝大多数、胞质完整均为70%(14/20),易见腺腔、腺管、炮竹、栅栏、单列纵队等特殊排列为35%(7/20),均明显高于13例细胞学过诊病例相对病例数,差异有统计学意义(P<0.05).结论乳腺癌细针穿刺的细胞形态学特点有:细胞数量较多,呈松散、紊乱样排列,以散在和(或)小细胞群为主;胞质完整;核增大,呈圆形或不规则圆形,边缘不整齐,核质比明显增大或减小,核仁增大,核大小差异明显;易见散在细胞,未见肌上皮细胞,可见坏死;与乳腺增生症、乳腺纤维腺瘤可以鉴别.圆形核细胞占绝大多数,细胞质完整,易见腺腔、腺管、炮竹、栅栏、单列纵队样特殊排列的细胞学特点,对疑难病例的鉴别诊断有帮助.
목적 총결유선암세침천자적세포형태학특점급감별진단.방법 관찰175례유선암세침천자적세포학도편여76례유선증생증、93례유선섬유선류대조분석;동시관찰20례세포학루진화저진유선암세포학도편여13례세포학과진병례대조분석.결과 175례유선암:세포배렬잡란무겁성96.6%(169/175),핵간소송배렬71.4%(125/175),이산재혹소세포군위주34.3%(60/175),핵중등대소이상81.1%(142/175),원형세포핵점절대다수88.6%(155/175),핵변연불정제28.6%(50/175),핵질비명현증대60%(105/175)、명현감소8.6%(15/175),대핵인28%(49/175),핵대소차이명현77.7%(136/175),미견기상피세포96%(168/175),가견배사13.7%(24/175),산재세포원형핵점절대다수89.7%(157/175)、포질완정66.9%(117/175),균명현고우유선증생증、유선섬유선류적상대병례수,차이균유통계학의의(P<0.05);세포수량다적、산재세포중등량이상적분별위52.6%(92/175)、55.4%(97/175),균명현고우유선증생증적5.3%(4/76)、14.5%(11/76),균P<0.05.20례세포학루진、저진유선암:원형핵세포점절대다수、포질완정균위70%(14/20),역견선강、선관、포죽、책란、단렬종대등특수배렬위35%(7/20),균명현고우13례세포학과진병례상대병례수,차이유통계학의의(P<0.05).결론 유선암세침천자적세포형태학특점유:세포수량교다,정송산、문란양배렬,이산재화(혹)소세포군위주;포질완정;핵증대,정원형혹불규칙원형,변연불정제,핵질비명현증대혹감소,핵인증대,핵대소차이명현;역견산재세포,미견기상피세포,가견배사;여유선증생증、유선섬유선류가이감별.원형핵세포점절대다수,세포질완정,역견선강、선관、포죽、책란、단렬종대양특수배렬적세포학특점,대의난병례적감별진단유방조.
Objective To summarize the cytological features of breast carcinoma by fine needle aspiration and differential diagonsis of breast hyperplasia and breast flbroadenoma. Methods Cytological features about 175 cases of breast cancer were analyzed,contrasted with 76 cases of breast hyperplasia and 93 eases of fibroadenoma. And 20 cases of low-diagnosis breast cancer were analyzed, compared with 13 cases of excessive diagnosis. Results The followings were found:disorderly arranged cells in 169 cases of breast cancer, about 96.9% in 175 cases,loose distance between the nucleus in 125 cases of all cases (about 71.4%). The percentage of small groups or scattered cells, medium size cells, round nucleus and irregular border nucleus was 34.3% (60/175) ,81.1% (142/175), 88.6% (155/175) and 28.6% (50/175) respectively. The nucleus/cytoplasm ratio was increased in 105 cases of all (about 60%). The nucleus/cytoplasm ratio was obviously reduced in 15 cases of all (about 8.6%). Big nucleolis were observed in 49 cases of all (about 28%). There was significant difference between nucleus size in 136 cases of all (about 77.7%). There was not myoepithelial cell in 168 cases of all (about 96%). The percentage of visible necrosis, scsttered round nucleus and integrity of cytoplasmic was 13.7% (24/175) ,89.7% (157/175), 66.9% (117/175) respectively. The cases of all above features were significantly more than those of breast hyperplasia and breast fibroadenoma (P <0.05). The percentage of large number of cells was 52.6% in 175 breast cancer cases,higher than 5.3% in 76 breast hyperplasia cases. There was a significant difference(P <0.05) between two groups. In 20 cases of low-diagnosis breast cancer the percentage of round nucleus with integrity of cytoplasmic, special arrangement cells was 70% (14 cases) ,35% (7 cases) ,higher than the cases in 13 excessive diagnosis cases. There was a significant difference(P < 0.05) between two groups. Conclusion The cell morphological characteristics of breast caner by fine needle aspiration are large number of cells, loose distance between the nucleus, disorderly arranged cells, small guoups or scattered cells, integrity of cytoplasmic, increased nuclear, round nuclear, irregular border nucleus,increased or decreased nucleus/cytoplasm ratio, big nucleoli, significant difference in nuclear size, no myoepithelial cell, visible necrosis. Most of breast cancer can be distinguished from breast hyperplasia and breast fibroadenoma by above characteristics. All those cytological characteristics are helpful to identify difficult case.