Kil Won-Ho, Cho Eun Yoon, Kim Jung Han, Nam Seok-Jin, Yang Jung-Hyun
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
Breast. 2008 Jun;17(3):258-62. doi: 10.1016/j.breast.2007.10.008. Epub 2007 Nov 28.
Debate continues regarding the use of surgical excision in benign papillary lesions initially diagnosed at core biopsy. The objective of this study is to propose management guidelines for benign papillary breast lesions initially diagnosed at core biopsy. Between January 2003 and January 2006, 76 lesions were identified as benign papillary lesions at initial core needle biopsy (n=68) or vacuum biopsy (n=8). After surgical excision, six of the 68 benign papillary lesions initially diagnosed at core needle biopsy were confirmed as malignant papillary neoplasms, giving a false-negative rate of core needle biopsy of 8.8%. Three of the eight atypical papillomas initially diagnosed at core needle biopsy were confirmed as papillary cancer in final pathology, giving a false-negative rate of 37.5%. In the analysis of the difference between benign papillary lesions and atypia or malignant papillary lesions, malignant papillary lesions were located more peripherally (p=0.005) than benign lesions and were larger (>1.5 cm, p=0.017). It is concluded that atypical papillomas at initial core biopsy or large, clinically peripherally located papillomas (>1.5 cm) need additional surgical excision.
对于最初在粗针活检时被诊断为良性乳头状病变的手术切除应用，仍存在争议。本研究的目的是为最初在粗针活检时被诊断为良性乳头状乳腺病变提出管理指南。在2003年1月至2006年1月期间，76个病变在初次粗针活检（n = 68）或真空活检（n = 8）时被确定为良性乳头状病变。手术切除后，最初在粗针活检时被诊断为良性乳头状病变的68个病变中有6个被确认为恶性乳头状肿瘤，粗针活检的假阴性率为8.8%。最初在粗针活检时被诊断为非典型乳头状瘤的8个病变中有3个在最终病理中被确认为乳头状癌，假阴性率为37.5%。在分析良性乳头状病变与非典型或恶性乳头状病变之间的差异时，恶性乳头状病变比良性病变更位于周边（p = 0.005）且更大（>1.5 cm，p = 0.017）。得出的结论是，初次粗针活检时的非典型乳头状瘤或大的、临床上位于周边的乳头状瘤（>1.5 cm）需要额外的手术切除。
