Brem R F, Behrndt V S, Sanow L, Gatewood O M
The Russell H. Morgan Department of Radiology and Radiological Science, The Breast Imaging and Interventional Center, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
AJR Am J Roentgenol. 1999 May;172(5):1405-7. doi: 10.2214/ajr.172.5.10227526.
This review was undertaken to determine the reliability of the histologic diagnosis of atypical ductal hyperplasia (ADH) made from tissue obtained by 11-gauge stereotactically guided directional vacuum-assisted biopsy of impalpable breast lesions.
Four hundred twenty-two 11-gauge stereotactically guided vacuum-assisted breast biopsies were performed at our institution between November 5, 1996, and June 30, 1998. Biopsies were performed with the patient prone on a dedicated stereotactic biopsy table. A directional vacuum-assisted biopsy device was used. Eight to 24 cores (mean, 13.4) were harvested from each lesion. Radiography of core specimens was performed in cases in which the target lesion contained microcalcifications. Twenty (4.7%) of the 422 biopsies yielded a histopathologic diagnosis of ADH. Surgical excision of 16 of the 20 lesions was subsequently performed. We compared the histopathologic results of the core extracted and the corresponding surgically excised tissue.
Of the 16 surgically excised lesions, four (25.0%) retained the diagnosis of ADH. Four (25%) were upgraded to carcinoma: Two (12.5%) were ductal carcinoma in situ without comedonecrosis, one (6.3%) was invasive carcinoma, and one (6.3%) was tubular carcinoma. Of the remaining eight surgically excised lesions, six (37.5%) were interpreted as benign fibrocystic changes with ductal hyperplasia without atypia, and two (12.5%) were interpreted as lobular carcinoma in situ.
Because ADH was underdiagnosed in 25% of the lesions, we recommend that surgical excision be performed whenever ADH is found in tissue obtained from 11-gauge directional vacuum-assisted breast biopsy.
本综述旨在确定通过11号立体定位引导下对不可触及乳腺病变进行定向真空辅助活检所获组织进行非典型导管增生（ADH）组织学诊断的可靠性。
1996年11月5日至1998年6月30日期间，在我们机构进行了422例11号立体定位引导下的真空辅助乳腺活检。活检时患者俯卧于专用立体定位活检台上。使用定向真空辅助活检装置。每个病变获取8至24条（平均13.4条）组织条。若目标病变含有微钙化，则对组织条进行射线照相。422例活检中有20例（4.7%）组织病理学诊断为ADH。随后对其中16例病变进行了手术切除。我们比较了所取组织条与相应手术切除组织的组织病理学结果。
16例手术切除的病变中，4例（25.0%）仍诊断为ADH。4例（25%）升级为癌：2例（12.5%）为无粉刺样坏死的导管原位癌，1例（6.3%）为浸润性癌，1例（6.3%）为小管癌。其余8例手术切除的病变中，6例（37.5%）被解释为伴有无 atypia导管增生的良性纤维囊性变，2例（12.5%）被解释为小叶原位癌。
由于25%的病变中ADH被漏诊，我们建议，当在11号定向真空辅助乳腺活检所获组织中发现ADH时，应进行手术切除。
