Valdes Edna K, Tartter Paul I, Genelus-Dominique Elvita, Guilbaud Deborah-Alexis, Rosenbaum-Smith Sharon, Estabrook Alison
Department of Surgery, Comprehensive Breast Service, St. Luke's Roosevelt Medical Center, 425 West 59th Street Suite 7A, New York, New York 10019, USA.
Ann Surg Oncol. 2006 Apr;13(4):480-2. doi: 10.1245/ASO.2006.08.001. Epub 2006 Feb 14.
The management of nonpalpable papillary lesions found in specimens obtained by percutaneous breast biopsy is controversial. We reviewed the treatment of patients found to have papillary lesions by stereotactic, sonographic, or fine-needle aspiration breast biopsy to identify indications for surgical excision.
Consecutive patients with intraductal papilloma, atypical papilloma/papilloma with atypical ductal hyperplasia, papillary neoplasm, and papillomatosis according to percutaneous breast biopsy were identified from radiology records. The charts were reviewed to identify patients who had subsequent surgical excision, and the pathologic findings were correlated with the biopsy method and indications for surgery.
Papillary lesions were found in 120 biopsy samples from 109 patients. Malignancy was found at operation in 19 (24%) of 80 lesions that underwent surgical excision: 12 (63%) were ductal carcinoma-in-situ, 4 (21%) were infiltrating ductal carcinoma, 2 (11%) were infiltrating papillary carcinoma, and 1 (5%) was intracystic papillary carcinoma. Malignancy was found in 9 (30%) of 30 fine-needle biopsy papillary lesions, 6 (35%) of 17 core biopsy papillary lesions, and 4 (12%) of 33 stereotactic biopsy papillary lesions. Malignancy was missed significantly less frequently with stereotactic biopsy (P<.05).
Malignancy is frequently found at surgical excision for papillary lesions found on percutaneous breast biopsy. Malignancy is missed significantly less frequently with stereotactic biopsy.
经皮乳腺活检标本中发现的不可触及的乳头状病变的处理存在争议。我们回顾了通过立体定位、超声或细针穿刺乳腺活检发现有乳头状病变的患者的治疗情况，以确定手术切除的指征。
从放射学记录中识别出根据经皮乳腺活检诊断为导管内乳头状瘤、非典型乳头状瘤/伴有非典型导管增生的乳头状瘤、乳头状肿瘤和乳头状瘤病的连续患者。查阅病历以确定随后接受手术切除的患者，并将病理结果与活检方法和手术指征相关联。
在109例患者的120份活检样本中发现了乳头状病变。在接受手术切除的80个病变中，有19个（24%）在手术中发现为恶性：12个（63%）为导管原位癌，4个（21%）为浸润性导管癌，2个（11%）为浸润性乳头状癌，1个（5%）为囊内乳头状癌。在30个细针穿刺活检乳头状病变中有9个（30%）发现为恶性，在17个粗针穿刺活检乳头状病变中有6个（35%），在33个立体定位活检乳头状病变中有4个（12%）。立体定位活检漏诊恶性病变的频率显著较低（P<0.05）。
经皮乳腺活检发现的乳头状病变在手术切除时经常发现为恶性。立体定位活检漏诊恶性病变的频率显著较低。
