Gevoeligheid en snelheid van de voorafgaande cel- en weefseldiagnostiek bij primair chirurgisch behandelde borstkankerpatiënten in twee ziekenhuizen, bepaald met behulp van PALGA-gegevens

Result and process testing of cell and tissue diagnostics, including the sentinel-gland procedure, executed on patients who underwent a primary surgical intervention for mammary carcinoma.

Design

Retrospective.

Method

In a group of 191 women who underwent 192 primary surgical interventions for breast cancer in 2002, data from the Pathological-Anatomical National Computerised Archive (PALGA) were examined with regard to which form of cell or tissue diagnosis was used and in how many stages the cancer diagnosis was morphologically established with sufficient certainty.

Results

In three-quarters of the women the diagnosis ‘cancer’ was established with certainty in the first stage. When the initial diagnosis was made using fine-needle cytological puncture, 35 of the 81 women had to undergo a second diagnostic test; with histological tests using needle biopsies this was 10 out of 92. The false-negative chance of fine-needle cytological tests was 13 (95 CI: 8-22) and for tests involving large-core needle biopsies 14 (95 CI: 8-23). A delay in treatment of more than 4 months occurred in 6 women due to the cancer being missed. A sentinel-gland procedure was performed on 58 of the women. In 33 women who underwent pre-operative ultrasound with fine-needle cytological testing of the axillary glands, the sensitivity for axillary gland metastases was 74 (95 CI: 53-87).

Conclusion

Looked at in terms of the practical guideline for diagnosis of breast cancer the cell and tissue diagnoses were adequate, but the standards prescribed in that guideline for the chances of a false-negative (5) were exceeded.