Grady Ian, Gorsuch Heidi, Wilburn-Bailey Shelly
North Valley Breast Clinic, Redding, CA 96001, USA.
J Am Coll Surg. 2005 Jul;201(1):14-7. doi: 10.1016/j.jamcollsurg.2005.02.025.
In October 2002, ultrasound-guided, vacuum-assisted, percutaneous excision was shown to facilitate the complete removal of benign breast lesions up to 3 cm in diameter. This study was performed to ascertain the overall accuracy of ultrasound-guided, vacuum-assisted, percutaneous excision as evidenced by the frequency of atypical ductal hyperplasia (ADH) underestimation.
A retrospective review was conducted of 542 consecutive ultrasound-guided, vacuum-assisted breast biopsies performed between February 2000 and September 2004. Before July 2002, no attempt was made to completely remove all imaged lesion evidence. After July 2002, all patients underwent complete percutaneous excision of all imaged lesion evidence. Pathology review revealed 52 lesions that demonstrated ADH and no evidence of malignancy. Each patient with this diagnosis was offered surgical excision. Pathologic reports for each group were compared with the subsequent open surgical specimens.
Of 542 consecutively diagnosed lesions, 52 displayed ADH with no evidence of malignancy (10%). Five patients refused operation. Of the 47 patients who underwent open excision, 6 (13%) were found to have malignancies. The rate of ADH underestimation was 6 of 18 (33%) in incisional biopsies and 0 of 29 performed with complete imaged lesion evidence (p=0.002). The rate of ADH underestimation in women who underwent ultrasound-guided, vacuum-assisted, percutaneous excision was zero, a result equivalent to open surgical biopsy.
ADH is a more common finding in sonographic lesions than has been previously reported. Complete ultrasound-guided, vacuum-assisted, percutaneous excision is more accurate than nonexcisional ultrasound-guided biopsy. Patients so diagnosed have very low underestimation rates and may not require open surgical reexcision.
2002年10月，有研究表明超声引导下的真空辅助经皮切除术有助于完整切除直径达3厘米的良性乳腺病变。本研究旨在通过非典型导管增生（ADH）低估频率来确定超声引导下真空辅助经皮切除术的总体准确性。
对2000年2月至2004年9月期间连续进行的542例超声引导下真空辅助乳腺活检进行回顾性分析。2002年7月之前，未尝试完全切除所有成像的病变证据。2002年7月之后，所有患者均接受了所有成像病变证据的完全经皮切除。病理检查发现52个病变显示为ADH且无恶性证据。对每例诊断为此病的患者均建议进行手术切除。将每组的病理报告与随后的开放手术标本进行比较。
在542例连续诊断的病变中，52例显示ADH且无恶性证据（10%）。5例患者拒绝手术。在47例接受开放切除的患者中，6例（13%）被发现患有恶性肿瘤。在切取活检中，ADH低估率为18例中的6例（33%），而在有完整成像病变证据的29例中为0例（p = 0.002）。接受超声引导下真空辅助经皮切除术的女性中ADH低估率为零，这一结果与开放手术活检相当。
ADH在超声检查病变中比先前报道的更为常见。完全的超声引导下真空辅助经皮切除术比非切除性超声引导活检更准确。如此诊断的患者低估率非常低，可能不需要进行开放手术再次切除。
