Liberman Laura, Tornos Carmen, Huzjan Renata, Bartella Lia, Morris Elizabeth A, Dershaw D David
Breast Imaging Research Programs, Breast Imaging Section, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA.
AJR Am J Roentgenol. 2006 May;186(5):1328-34. doi: 10.2214/AJR.05.0151.
The study objective was to determine the cancer frequency in lesions yielding a benign, concordant diagnosis of papilloma at percutaneous breast biopsy.
Retrospective review was performed of 3,864 lesions that had percutaneous imaging-guided biopsy. In 50 lesions (1.3%), percutaneous biopsy yielded a benign, concordant diagnosis of papilloma. Surgical pathology (n = 25) or minimum 2 years' mammographic follow-up (n = 10) was available for 35 lesions that had biopsy with 11-gauge vacuum-assisted (n = 20) or 14-gauge automated (n = 15) needles. Medical records, imaging studies, and histologic results were reviewed.
Cancer was found in five (14%) of the 35 lesions yielding a benign, concordant diagnosis of papilloma at percutaneous biopsy. Cancer histology was ductal carcinoma in situ in four (80%) and node-negative invasive cancer in one. Four (80%) of five cancers were identified due to interval change at follow-up (median, 22 months; range, 7-25 months). In six (17%) of 35 lesions, surgery revealed high-risk lesions including atypical ductal hyperplasia (n = 3), radial scar (n = 2), and lobular carcinoma in situ (n = 1). There was a significantly (p = 0.02) higher frequency of cancer or high-risk lesion in women with multiple versus solitary papillomas and a trend (p = 0.09) toward a higher cancer rate in women with versus without a family history of breast cancer. Breast cancer history, menopausal status, mammographic pattern, biopsy method, and removal of imaging target had no significant impact on cancer rate.
In our study of percutaneously diagnosed papillomas, surgery revealed cancer in 14% and high-risk lesions in 17%. Lesions yielding a benign, concordant diagnosis of papilloma at percutaneous biopsy may warrant surgical excision.
本研究的目的是确定经皮乳腺活检诊断为良性、一致的乳头状瘤病变中的癌症发生率。
对3864例经皮影像引导活检的病变进行回顾性研究。在50例病变（1.3%）中，经皮活检诊断为良性、一致的乳头状瘤。35例经11号真空辅助活检针（n = 20）或14号自动活检针（n = 15）活检的病变中，有25例可获得手术病理结果，10例至少有2年的乳腺X线随访结果。对病历、影像学检查和组织学结果进行了回顾。
在经皮活检诊断为良性、一致的乳头状瘤的35例病变中，有5例（14%）发现癌症。癌症组织学类型为导管原位癌4例（80%），1例为无淋巴结转移的浸润性癌。5例癌症中有4例（80%）是由于随访期间的间隔变化而确诊的（中位时间22个月；范围7 - 25个月）。在35例病变中的6例（17%）中，手术发现高危病变，包括非典型导管增生（n = 3）、放射状瘢痕（n = 2）和小叶原位癌（n = 1）。有多个乳头状瘤的女性与单个乳头状瘤的女性相比，癌症或高危病变的发生率显著更高（p = 0.02），有乳腺癌家族史的女性与无乳腺癌家族史的女性相比，癌症发生率有升高趋势（p = 0.09）。乳腺癌病史、绝经状态、乳腺X线表现、活检方法以及影像目标的切除对癌症发生率无显著影响。
在我们对经皮诊断的乳头状瘤的研究中，手术发现14%的病变为癌症，17%为高危病变。经皮活检诊断为良性、一致的乳头状瘤病变可能需要手术切除。
