Mendez Angela, Cabanillas Fernando, Echenique Miguel, Malekshamran Keyvan, Perez Iris, Ramos Edwin
Auxilio Mutuo Cancer Center, Hospital Auxilio Mutuo, San Juan, Puerto Rico.
Cancer. 2004 Feb 15;100(4):710-4. doi: 10.1002/cncr.20017.
Breast Imaging Reporting and Data System (BI-RADS) Category 3 represents 'probably benign' mammographic abnormalities requiring close follow-up, but biopsies sometimes are performed on Category 3 abnormalities. Controversy exists as to when these biopsies are justified. The goals of the current study were to evaluate the use of stereotactic vacuum-assisted breast biopsy (SVABB) for BI-RADS 3 lesions in a nonacademic community hospital-based practice, to evaluate the false- negative rate of Category 3 mammograms, and to determine whether any specific lesions misinterpreted as BI-RADS 3 abnormalities might commonly be associated with malignant disease.
From August 2000 to December 2002, the authors performed 947 SVABB procedures on 911 patients. They focused on 156 SVABBs of BI-RADS 3 abnormalities.
Of 634 SVABB procedures requested by outside sources, 114 (18%) were performed for BI-RADS 3 abnormalities, compared with 42 (13%) of 313 SVABB procedures that were performed based on mammographic findings at the authors' practice (P = 0.075). After SVABB, 7 of 156 patients with BI-RADS 3 lesions were diagnosed with breast carcinoma and 1 was diagnosed with atypical ductal hyperplasia. Therefore, the false-negative rate of BI-RADS 3 mammograms was 4.5% (i.e., 7 of 156 patients). Patients with linear microcalcifications had the highest rate of cancer (4 of 14 [29%]) compared with patients without microcalcifications (1 of 64 [1.5%]) and patients with nonlinear microcalcifications (2 of 69 [2.9%]).
The use of SVABB for BI-RADS 3 lesions reflected uncertainty regarding the potential for a diagnosis of malignant disease rather than the financial incentive of performing a biopsy. SVABB was not necessary for patients with BI-RADS 3 lesions without microcalcifications or for patients with nonlinear microcalcifications. Lesions with linear (casting or branching) microcalcifications should not be considered BI-RADS 3 abnormalities.
乳腺影像报告和数据系统（BI-RADS）3类代表“可能为良性”的乳腺钼靶异常，需要密切随访，但有时也会对3类异常进行活检。对于何时进行这些活检是合理的存在争议。本研究的目的是评估在一家非学术性社区医院开展的基于实践中，立体定向真空辅助乳腺活检（SVABB）用于BI-RADS 3类病变的情况，评估3类乳腺钼靶的假阴性率，并确定是否有任何被误诊为BI-RADS 3类异常的特定病变可能通常与恶性疾病相关。
2000年8月至2002年12月，作者对911例患者进行了947例SVABB手术。他们重点关注了156例针对BI-RADS 3类异常的SVABB手术。
在外院要求的634例SVABB手术中，114例（18%）是针对BI-RADS 3类异常进行的，相比之下，在作者所在医院基于钼靶检查结果进行的313例SVABB手术中有42例（13%）（P = 0.075）。SVABB术后，156例BI-RADS 3类病变患者中有7例被诊断为乳腺癌，1例被诊断为非典型导管增生。因此，BI-RADS 3类乳腺钼靶的假阴性率为4.5%（即156例患者中的7例）。与无微钙化的患者（64例中的1例[1.5%]）和无非线性微钙化的患者（69例中的2例[2.9%]）相比，有线性微钙化的患者癌症发生率最高（14例中的4例[29%]）。
对BI-RADS 3类病变使用SVABB反映了对恶性疾病诊断可能性的不确定性，而非进行活检的经济诱因。对于没有微钙化的BI-RADS 3类病变患者或无非线性微钙化的患者，SVABB并非必要。具有线性（铸型或分支状）微钙化的病变不应被视为BI-RADS 3类异常。
