Lam W W M, Chu W C W, Tang A P Y, Tse G, Ma T K F
Department of Diagnostic Radiology and Organ Imaging, Rm. 27029, Prince of Wales Hospital, Ngan Shing St., Shatin, Hong Kong.
AJR Am J Roentgenol. 2006 May;186(5):1322-7. doi: 10.2214/AJR.04.1908.
The purpose of our study was to assess the role of imaging and core biopsy in the management of patients with papillary lesions of the breast.
Clinical records and mammographic and sonographic findings of 40 women with papillary lesions in the breast were retrieved. The imaging features and cytologic findings were correlated with histologic findings.
Fifty-six papillary lesions in 40 patients underwent either mastectomy, segmental duct resection, or excision biopsy. There were three papillary carcinomas, 13 papillaryal lesions with carcinoma in situ, one atypical papilloma, four sclerosed papillomata, and 35 papillomata. Of these lesions, 37.5% (21/56) and 82.1% (46/56) could be detected on mammography and sonography, respectively. Galactography and dilated ducts helped to suggest the papillary nature of the lesions. However, mammography and sonography were not able to predict malignancy (sensitivity, 69% and 56%, respectively; specificity, 25% and 90%; positive predictive value [PPV], 60% and 75%; and negative predictive value [NPV], 33% and 90%). Combined interpretation of mammography and sonography gave a sensitivity of 61%, specificity of 33%, PPV of 85%, and NPV of 13%. Fine-needle aspiration gave a sensitivity of 44%, specificity of 68%, PPV of 31%, and NPV of 79%, whereas core biopsy gave a sensitivity of 82%, specificity of 100%, PPV of 100%, and NPV of 83% in the diagnosis of malignancy.
Radiologic features are not sufficiently sensitive or specific to differentiate benign from malignant papillary lesions. Fine-needle aspiration and core biopsy have pitfalls, and the need for surgical excision of all papillary lesions should be revisited.
本研究的目的是评估影像学检查和粗针活检在乳腺乳头状病变患者管理中的作用。
检索了40例乳腺乳头状病变女性的临床记录以及乳腺X线摄影和超声检查结果。将影像学特征和细胞学检查结果与组织学检查结果进行关联分析。
40例患者中的56个乳头状病变接受了乳房切除术、区段性导管切除术或切除活检。其中有3例乳头状癌、13例伴有原位癌的乳头状病变、1例非典型乳头状瘤、4例硬化性乳头状瘤和35例乳头状瘤。在这些病变中，乳腺X线摄影和超声检查分别能检测出37.5%（21/56）和82.1%（46/56）的病变。乳腺导管造影和扩张的导管有助于提示病变的乳头状性质。然而，乳腺X线摄影和超声检查无法预测恶性病变（敏感性分别为69%和56%；特异性分别为25%和90%；阳性预测值[PPV]分别为60%和75%；阴性预测值[NPV]分别为33%和90%）。乳腺X线摄影和超声检查联合解读的敏感性为61%，特异性为33%，PPV为85%，NPV为13%。细针穿刺活检的敏感性为44%，特异性为68%，PPV为31%，NPV为79%，而粗针活检在恶性病变诊断中的敏感性为82%，特异性为100%，PPV为100%，NPV为83%。
放射学特征在鉴别良性和恶性乳头状病变方面不够敏感或特异。细针穿刺活检和粗针活检存在缺陷，应重新审视对所有乳头状病变进行手术切除的必要性。
