Zografos George C, Zagouri Flora, Sergentanis Theodoros N, Koulocheri Dimitra, Nonni Afroditi, Oikonomou Vassiliki, Domeyer Philip, Kotsani Maria, Fotiadis Constantine, Bramis John
1st Department of surgery, School of Medicine, Athens University, Greece.
World J Surg Oncol. 2007 May 14;5:53. doi: 10.1186/1477-7819-5-53.
Vacuum-Assisted Breast Biopsy (VABB) is effective for the preoperative diagnosis of non-palpable mammographic solid lesions. The main disadvantage is underestimation, which might render the management of atypical ductal hyperplasia (ADH), and ductal carcinoma in situ (DCIS) difficult. This study aims to develop and assess a modified way of performing VABB.
A total of 107 women with non-palpable mammographic breast solid tumors BI-RADS 3 and 4 underwent VABB with 11G, on the stereotactic Fischer's table. 54 women were allocated to the recommended protocol and 24 cores were obtained according to the consensus meeting in Nordesterdt (1 offset-main target in the middle of the lesion and one offset inside). 53 women were randomly allocated to the extended protocol and 96 cores were excised (one offset-main target in the middle of the lesion and 7 peripheral offsets). A preoperative diagnosis was established. Women with a preoperative diagnosis of precursor/preinvasive/invasive lesion underwent open surgery. A second pathologist, blind to the preoperative results and to the protocol made the postoperative diagnosis. The percentage of the surface excised via VABB was retrospectively calculated on the mammogram. The discrepancy between preoperative and postoperative diagnoses along with the protocol adopted and the volume removed were evaluated by Fisher's exact test and Mann-Whitney-Wilcoxon test, respectively.
Irrespectively of the protocol adopted, 82.2% of the lesions were benign. 14.0% of the lesions were malignancies (5.1% of BI-RADS 3, 5.3% of BI-RADS 4A, 25% of BI-RADS 4B, and 83.3% of BI-RADS 4C lesions). 3.7% of the biopsies were precursor lesions. There was no evidence of underestimation in either protocols. In the standard protocol, the preoperative/postoperative diagnoses were identical. In the extended protocol, the postoperative diagnosis was less severe than the preoperative in 55.5% of cases (55.5% vs. 0%, p = 0.029), and preoperative ADH was totally removed. The phenomenon of discrepancy between diagnoses was associated with larger volume removed (8.20 +/- 1.10 vs. 3.32 +/- 3.50 cm3, p = 0.037) and higher removed percentage of the lesion (97.83 +/- 4.86% vs. 74.34 +/- 23.43%, p = 0.024)
The extended protocol seems to totally excise precursor lesions, with minimal underestimation. This might possibly point to a modified management of ADH lesions.
真空辅助乳腺活检（VABB）对于乳腺钼靶检查中不可触及的实性病变的术前诊断是有效的。其主要缺点是低估，这可能使非典型导管增生（ADH）和导管原位癌（DCIS）的处理变得困难。本研究旨在开发并评估一种改良的VABB操作方法。
107例乳腺钼靶检查发现不可触及的乳腺实性肿瘤且BI-RADS分类为3类和4类的女性，在立体定位Fischer台上接受11G的VABB。将54例女性分配至推荐方案组，根据诺德施泰特共识会议的建议获取24条组织芯（在病变中心取1条偏移主靶点组织芯和在病变内部取1条偏移组织芯）。将53例女性随机分配至扩展方案组，切除96条组织芯（在病变中心取1条偏移主靶点组织芯和7条周边偏移组织芯）。进行术前诊断。术前诊断为前驱/原位/浸润性病变的女性接受开放手术。另一位对术前结果和方案不知情的病理学家进行术后诊断。通过乳腺钼靶片回顾性计算VABB切除组织的表面百分比。术前与术后诊断的差异以及所采用的方案和切除体积分别采用Fisher精确检验和Mann-Whitney-Wilcoxon检验进行评估。
无论采用何种方案，82.2%的病变为良性。14.0%的病变为恶性（BI-RADS 3类病变的5.1%，BI-RADS 4A类病变的5.3%，BI-RADS 4B类病变的25%，BI-RADS 4C类病变的83.3%）。3.7%的活检为前驱病变。两种方案均无低估的证据。在标准方案中，术前/术后诊断一致。在扩展方案中，55.5%的病例术后诊断比术前轻（55.5%对0%，p = 0.029），且术前ADH被完全切除。诊断差异现象与切除体积较大（8.20±1.10对3.32±3.
