Ashkenazi Itamar, Ferrer Karen, Sekosan Marin, Marcus Elizabeth, Bork Jeff, Aiti Tamer, Lavy Ron, Zaren Howard A
John H. Stroger, Jr. Hospital of Cook County Minority-Based Community Clinical Oncology Program, 1900 West Polk St, Chicago, IL 60612, USA.
Am J Surg. 2007 Aug;194(2):183-8. doi: 10.1016/j.amjsurg.2006.11.028.
A review of the literature reveals conflicting evidence on whether core biopsy, complemented with concordant imaging, is sufficient in differentiating benign from malignant papillary lesions. Our objective was to evaluate whether in our patient population, commonly used clinical and pathological parameters could predict benignity, thus eliminating the need to proceed with excision.
A retrospective review of clinical variables and pathologic slides of 39 patients in whom both core biopsy and excisional biopsy were available for evaluation.
Excision revealed malignancy in 44%. Risk factors for malignancy, palpability, size, or Breast Imaging Reporting and Data System (American College of Radiology, Reston, VA) did not help differentiate benign from malignant disease. Younger age and core biopsies revealing minimal or no atypia were predictive of benignity. However, 4 (25%) of 20 patients whose core biopsies were classified as probably benign were found to have malignancy on excision.
Caution should be used in recommending nonoperative management after a core biopsy revealing a papillary lesion.
文献综述显示，关于在影像检查结果一致的情况下，粗针活检是否足以鉴别乳头状病变的良恶性，证据相互矛盾。我们的目的是评估在我们的患者群体中，常用的临床和病理参数能否预测病变为良性，从而无需进行切除手术。
回顾性分析39例患者的临床变量和病理切片，这些患者同时有粗针活检和切除活检结果可供评估。
切除活检显示44%为恶性。恶性风险因素，如可触及性、大小或乳腺影像报告和数据系统（美国放射学会，弗吉尼亚州雷斯顿），无助于区分良性和恶性疾病。年龄较小以及粗针活检显示极少或无异型性可预测为良性。然而，20例粗针活检分类为可能良性的患者中，有4例（25%）切除后发现为恶性。
粗针活检显示乳头状病变后推荐非手术治疗时应谨慎。
