当院における乳腺細胞診の診断困難例，誤陰性・誤陽性例の再検討

摘要

乳腺穿刺吸引細胞診（FNA）は乳癌診断にて簡易かつ有効な診断方法だが，多彩な像を呈する乳腺疾rn患ではしばしば判定に難渋し，判定困難例，誤診断例が発生する．当院の乳腺症例検討会で検討されたrn168例にて，細胞診での診断困難例及び誤診断症例を選びその原因を検討した．判定困難・誤診断の主rnな原因は採取細胞量が少ない，変性が強い，細胞異型が弱い，筋上皮細胞が不明瞭などであった．細胞rnが充分に採取されているにも関ゎらず，細胞が小型で異型が弱く細胞診で良性としたが組織診では悪性rn細胞異型が強く壊死があり細胞彦で悪性としたが組織診では良性，と誤診断してしまった症例も含まれrnた．これらの誤診断を防ぐためには外科医，病理医，細胞検査士が連携し，臨床所見，画像所見，細胞rn所見全てを総合して良悪性，組織像を推定する必要がある．今回の検討で，これらの所見間に少しでもrn矛盾点がある場合は再検あるいは生検をするべきだと痛感した．%Fine needle aspiration cytology (FNA) is one of the most popular diagnostic exams for mammary gland disease because of its convenience and efficiency. But we sometimes experience difficulty in making a diagnosis with the case with multiple changes by FNA.rnWe have reviewed 168 cases from the Breast Case Conferences at our hospital and determined the problems which resulted in misdiagnosis or undiagnosability. Misdiagnosis and undiagnosability were "mainly caused by the poor sample cells, degenerated tissue, minimal change, and poor orientation. Among them, some cases which were diagnosed as benign by FNA because of minimal change and its small cell size with satisfying sample cells, found out malignancy by tissue sample examination. Other cases which were diagnosed as malignancy by FNA because of atypical cells and necrotic tissue, found out benign later.rnWe have strongly realized that pathologists, surgeons and cytotechnologists should have nice relationships among them to discuss the case with summarized information of the case including clinical findings, imaging study findings, and cytological findings about the cases. And if there is any discrepancy found, we have to request re-FNA or biopsy to make final diagnosis.