Bauer Valerie P, Ditkoff Beth Ann, Schnabel Freya, Brenin David, El-Tamer Mahmoud, Smith Suzanne
Department of Surgery, Columbia-Presbyterian Breast Center, Columbia University, New York, New York 10032, USA.
Breast J. 2003 Jan-Feb;9(1):4-9. doi: 10.1046/j.1524-4741.2003.09102.x.
The management of lobular neoplasia (LN) found on percutaneous core biopsy remains a clinical dilemma. The purpose of this study was to establish guidelines for the management of LN when obtained on percutaneous core needle biopsy. A retrospective review of the Breast Imaging Tissue Sampling Database at New York Presbyterian Hospital-Columbia Comprehensive Breast Center was performed from 1998 to 2000. A total of 1460 percutaneous core breast biopsies were performed using 11- or 14-gauge needles with LN identified in 43 biopsies from 34 patients. Eleven biopsies were ultrasound guided for nonpalpable masses and 32 were stereotactically guided for mammographically detected densities (10) and microcalcifications (22). The 43 LN biopsies were divided into three groups based on additional findings associated with LN on core biopsy: group I (n = 19), LN with invasive cancer or ductal carcinoma in situ (DCIS); group II (n = 11), LN plus a second indication for open surgical biopsy, such as atypical ductal hyperplasia (ADH), radial scar, phyllodes tumor, or intraductal papilloma; and group III (n = 13), LN plus benign fibrocystic changes. In group I, 19 of 19 biopsies (100%) yielded invasive cancer or DCIS on surgical biopsy versus 3 of 11 (27%) for group II, and 1 of 13 (8%) for group III. Outcomes in group III are described as follows: three patients were lost to follow-up, three patients did not undergo surgical biopsy but demonstrated more than 1 year of mammographic stability following core biopsy. Of the remaining seven patients, two had LN and ADH on surgical biopsy (one had a contralateral cancer), one had atypical lobular hyperplasia (with a contralateral cancer), two had LN and benign fibrocystic changes, one had LN and intraductal papilloma, and one had LN and invasive ductal carcinoma (IDC) with DCIS (with a contralateral cancer). These results suggest that surgical biopsy is indicated for patients with LN when found on core biopsy and when the biopsy demonstrates invasive cancer, DCIS, or other indications for surgical biopsy such as ADH, or in the examination of a patient with a synchronous contralateral breast cancer. The diagnosis of LN alone without these indications on percutaneous biopsy may not warrant routine surgical biopsy.
经皮穿刺活检发现的小叶瘤变（LN）的处理仍是一个临床难题。本研究的目的是制定经皮穿刺针吸活检发现LN时的处理指南。对1998年至2000年纽约长老会医院 - 哥伦比亚综合乳腺中心的乳腺影像组织采样数据库进行了回顾性研究。共进行了1460例经皮穿刺乳腺活检，使用11号或14号针，在34例患者的43次活检中发现了LN。11次活检是超声引导下针对不可触及肿块进行的，32次是立体定位引导下针对乳腺X线摄影发现的密度改变（10例）和微钙化（22例）进行的。根据穿刺活检时与LN相关的其他发现，将43例LN活检分为三组：第一组（n = 19），LN合并浸润性癌或导管原位癌（DCIS）；第二组（n = 11），LN加上开放手术活检的第二个指征，如非典型导管增生（ADH）、放射状瘢痕、叶状肿瘤或导管内乳头状瘤；第三组（n = 13），LN加上良性纤维囊性改变。在第一组中，19例活检中有19例（100%）手术活检发现浸润性癌或DCIS，而第二组11例中有3例（27%），第三组13例中有1例（8%）。第三组的结果如下：3例患者失访，3例患者未接受手术活检，但穿刺活检后乳腺X线摄影显示超过1年稳定。其余7例患者中，2例手术活检发现LN和ADH（1例对侧有癌），1例有非典型小叶增生（对侧有癌），2例有LN和良性纤维囊性改变，1例有LN和导管内乳头状瘤，1例有LN和浸润性导管癌（IDC）合并DCIS（对侧有癌）。这些结果表明，经皮穿刺活检发现LN且活检显示浸润性癌、DCIS或其他手术活检指征（如ADH）时，或在检查同步对侧乳腺癌患者时，患者应进行手术活检。经皮穿刺活检仅发现LN而无这些指征可能无需常规手术活检。
