Liu X, Inciardi M, Bradley J P, Fan F, Thomas P, Smith W, Tawfik O
Departmentof Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
Pathologica. 2007 Feb;99(1):5-10.
Core needle biopsies (CNBs) of the breast are highly sensitive techniques for sampling of mammographic calcifications. Currently, there is no standardized protocol for evaluating such samples. This study was undertaken to attempt to standardize the procedure of correlating histologic findings with mammographically detectable calcification. 113 CNBs with mammographic evidence of calcification were first reviewed and histologically categorized into 2 main groups based on the presence or absence of microcalcifications. Biopsies with microcalcifications were divided into < 100 microm and > or = 100 microm subgroups based on microcalcifications largest diameter either in aggregate or in isolation. Tissue blocks from discrepant biopsies (negative and < 100 microm microcalcifications) were radiographed. Deeper sectioning into the blocks was performed for discrepant biopsies. 102 of 113 CNBs (90.2%) had microcalcifications on primary review; 11 were negative and 21 had microcalcifications (< 100 microm) considered below the limit of mammographic detectability. Following tissue block radiology and deeper sectioning, large microcalcifications > or = 100 microm were identified in 12 discrepant biopsies (1 negative and 11 < 100 microm). Without careful evaluation 10 discrepant biopsies would have been erroneously reported as "false" positive and one as "false" negative for microcalcifications. In conclusion, tissue block radiography and deeper sectioning is required to assess microcalcifications in all discrepant cases. We recommend a systematic approach to standardize reporting of microcalcifications in CNBs. Pathologists should routinely report the size of microcalcifications in their reports and correlate their findings with the tissue block radiologic findings. Discrepant "false-positive with < 100 microm microcalcifications" biopsies should be considered non-diagnostic and should be handled the same way as "negative" biopsies.
乳腺粗针活检（CNB）是对乳腺钼靶钙化灶进行取样的高度敏感技术。目前，对于此类样本的评估尚无标准化方案。本研究旨在尝试使组织学检查结果与钼靶可检测钙化灶相关联的程序标准化。首先回顾了113例有钼靶钙化证据的CNB，并根据是否存在微钙化在组织学上分为2个主要组。有微钙化的活检样本根据微钙化最大直径（无论是聚集还是孤立状态）分为<100微米和≥100微米亚组。对不一致活检样本（阴性和<100微米微钙化）的组织块进行射线照相。对不一致活检样本进行更深层次的切片。113例CNB中有102例（90.2%）在初次检查时有微钙化；11例为阴性，21例有被认为低于钼靶可检测下限的微钙化（<100微米）。经过组织块放射学检查和更深层次切片后，在12例不一致活检样本（1例阴性和11例<100微米）中发现了≥100微米的大微钙化。如果不进行仔细评估，10例不一致活检样本会被错误地报告为微钙化“假”阳性，1例报告为“假”阴性。总之，对于所有不一致的病例，都需要进行组织块放射照相和更深层次切片以评估微钙化。我们建议采用系统方法使CNB中微钙化的报告标准化。病理学家应在报告中常规报告微钙化的大小，并将其检查结果与组织块放射学检查结果相关联。不一致的“<100微米微钙化假阳性”活检样本应被视为非诊断性样本，并应与“阴性”活检样本以相同方式处理。
