Mahoney Mary C, Robinson-Smith Toni M, Shaughnessy Elizabeth A
Department of Radiology, University of Cincinnati, 234 Goodman St., M.L. 772, Cincinnati, OH 45267, USA.
AJR Am J Roentgenol. 2006 Oct;187(4):949-54. doi: 10.2214/AJR.05.0710.
The objective of our study was to evaluate the outcome of lobular neoplasia diagnosed at 11-gauge stereotactic vacuum-assisted biopsy (SVAB).
Retrospective review of 1,819 lesions sampled with 11-gauge SVAB yielded 27 patients with lobular neoplasia as the most severe pathologic entity diagnosed. Patients with lobular neoplasia associated with atypical ductal hyperplasia (ADH), ductal carcinoma in situ (DCIS), or infiltrating carcinoma were excluded. Twenty patients underwent surgical excisional biopsy, and seven patients were followed mammographically for a mean of 52 months (range, 14-67 months). Mammographic lesion type, number of specimens obtained per lesion, and specific histologic features related to lobular carcinoma in situ (LCIS) were assessed. Results were compared with histologic findings at surgery or mammographic follow-up.
Nineteen lesions presented mammographically as microcalcifications, four as masses, three as masses with associated microcalcifications, and one as architectural distortion. A mean of 13 specimens were obtained per lesion. Carcinoma was found at surgical excision in 19% of the lesions (5/27). Lesions were upgraded to DCIS (n = 2), invasive lobular carcinoma (n = 2), and mixed invasive ductal and lobular carcinoma (n = 1). In addition to the diagnosis of lobular neoplasia at SVAB, one patient presented with synchronous infiltrating ductal carcinoma in the contralateral breast, and two patients developed metachronous infiltrating ductal carcinoma in a different quadrant of the ipsilateral breast. Twelve of the 27 lesions included LCIS. These lesions were evaluated pathologically to distinguish the classic (10/12) from the pleomorphic (2/12) form of this entity. Ten of the 12 LCIS cases underwent surgical excisional biopsy with four of the five upgrades occurring in these patients. Only one of these patients was shown to have the pleomorphic type of LCIS. Lesions in seven patients who underwent mammographic follow-up remained stable.
The known association of lobular neoplasia with high-risk and malignant lesions at surgical biopsy requires careful consideration when lobular neoplasia is diagnosed as the most severe histologic entity at SVAB. The diagnosis of lobular neoplasia at 11-gauge SVAB is not reliable in view of the 19% upgrade rate at the time of surgical excisional biopsy in our study. No predictive mammographic features allowed distinction between the patients with lesions that were upgraded at the time of surgery from those whose lesions were not upgraded.
我们研究的目的是评估在11号立体定位真空辅助活检（SVAB）时诊断的小叶瘤变的结果。
对1819例经11号SVAB取样的病变进行回顾性分析，发现27例患者以小叶瘤变为最严重的病理诊断。排除伴有非典型导管增生（ADH）、导管原位癌（DCIS）或浸润性癌的小叶瘤变患者。20例患者接受了手术切除活检，7例患者接受了平均52个月（范围14 - 67个月）的乳腺钼靶随访。评估乳腺钼靶病变类型、每个病变获取的标本数量以及与小叶原位癌（LCIS）相关的特定组织学特征。将结果与手术时的组织学发现或乳腺钼靶随访结果进行比较。
19个病变在乳腺钼靶上表现为微钙化，4个表现为肿块，3个表现为伴有微钙化的肿块，1个表现为结构扭曲。每个病变平均获取13个标本。手术切除时在19%的病变（5/27）中发现癌。病变升级为DCIS（n = 2）、浸润性小叶癌（n = 2）和浸润性导管癌与小叶癌混合（n = 1）。除了在SVAB时诊断为小叶瘤变外，1例患者对侧乳腺出现同步浸润性导管癌，2例患者同侧乳腺不同象限出现异时性浸润性导管癌。27个病变中有12个包含LCIS。对这些病变进行病理评估以区分该实体的经典型（10/12）和多形型（2/12）。12例LCIS病例中有10例接受了手术切除活检，其中升级的5例中有4例发生在这些患者中。这些患者中只有1例显示为多形型LCIS。7例接受乳腺钼靶随访的患者病变保持稳定。
当在SVAB时将小叶瘤变诊断为最严重的组织学实体时，鉴于小叶瘤变与手术活检时的高危和恶性病变之间已知的关联，需要仔细考虑。鉴于我们研究中手术切除活检时19%的升级率，11号SVAB时小叶瘤变的诊断不可靠。没有预测性的乳腺钼靶特征能够区分手术时病变升级的患者和病变未升级的患者。
