El-Tamer M, Axiotis C, Kim E, Kim J, Wait R, Homel P, Braverman A
Department of Surgery, Columbia-Presbyterian Medical Center, New York, NY, USA.
Ann Surg Oncol. 1999 Jul-Aug;6(5):461-6. doi: 10.1007/s10434-999-0461-1.
Neoadjuvant chemotherapy facilitates breast conservation in stage II breast cancer patients, whose primary tumors are assumed to be invasive because they are palpable. However, chemotherapy may not be indicated in the minority of patients whose clinically T2 tumors are completely or predominantly in situ. Almost all previous studies of core needle biopsy in breast cancer have been concerned with nonpalpable, mammographically detected tumors, and none have evaluated its ability to quantitatively determine the amounts of in situ and invasive disease.
From September, 1992 to December, 1997, core needle biopsy was performed on all patients presenting to the Kings County Hospital Breast Clinic with palpable breast masses. Carcinoma was present in both core needle biopsy samples and surgical specimens subsequently obtained from 95 of 99 patients. Each specimen was evaluated for tumor type, histologic grade, and the amounts of in situ and invasive carcinoma it contained, and the results from surgical and core needle biopsy specimens from the same patients were then compared.
The surgical specimens of 14 patients had completely or predominantly in situ disease. Completely or predominantly invasive disease was present in 67 specimens, and the remaining 14 had significant amounts of both. The high level of agreement between the amounts of in situ and invasive disease in core needle biopsy and surgical specimens is indicated by Pearson and intraclass correlation coefficients of 0.91 (P < .001 and < .00001, respectively). Tumor type was correctly predicted by core needle biopsy in each case. Variables among these patients, including primary tumor size, interval between biopsy and surgery, or administration of neoadjuvant systemic therapy, did not alter agreement between core needle biopsy and surgical specimens.
Core needle biopsy can identify palpable breast tumors that are predominantly or completely in situ, and, thus, avoid unnecessary neoadjuvant chemotherapy. It also can demonstrate that a tumor is predominantly invasive, but cannot rule out small invasive foci. For that purpose, complete surgical excision of the tumor is required.
新辅助化疗有助于II期乳腺癌患者保乳，这类患者的原发肿瘤因可触及而被认为是浸润性的。然而，对于少数临床T2期肿瘤完全或主要为原位癌的患者，可能无需进行化疗。几乎所有既往关于乳腺癌粗针活检的研究都针对不可触及的、乳腺X线检查发现的肿瘤，尚无研究评估其定量测定原位癌和浸润癌数量的能力。
1992年9月至1997年12月，对所有前往国王郡医院乳腺诊所就诊、有可触及乳腺肿块的患者进行粗针活检。99例患者中有95例粗针活检样本及随后获得的手术标本均发现癌。对每个标本评估肿瘤类型、组织学分级以及所含原位癌和浸润癌的数量，然后比较同一患者手术标本和粗针活检标本的结果。
14例患者的手术标本完全或主要为原位癌。67例标本为完全或主要浸润性癌，其余14例两者均有显著数量。粗针活检标本和手术标本中原位癌和浸润癌数量之间的高度一致性通过Pearson相关系数和组内相关系数0.91得以体现（P分别<0.001和<0.00001）。每种情况下粗针活检均能正确预测肿瘤类型。这些患者的变量，包括原发肿瘤大小、活检与手术间隔时间或新辅助全身治疗的应用，均未改变粗针活检与手术标本之间的一致性。
粗针活检能够识别主要或完全为原位癌的可触及乳腺肿瘤，从而避免不必要的新辅助化疗。它也能证明肿瘤主要为浸润性，但不能排除小的浸润灶。为此，需要对肿瘤进行完整的手术切除。
