Egyed Zsófia, Péntek Zoltán, Járay Balázs, Kulka Janina, Svastics Egon, Kas József, László Zsolt
Mamma Breast Health Corporation, Kapás u. 29, Budapest, H-1023, Hungary.
Pathol Oncol Res. 2008 Jun;14(2):123-9. doi: 10.1007/s12253-008-9025-0. Epub 2008 Apr 12.
The prevalence of radial scar (RS) is 0.04% in asymptomatic women participating in population screening for breast cancer. It is important to differentiate RS from concomitant malignancies, which occur in 20-30% of patients, or from small stellate carcinomas which give similar radiomorphology. The aim of our study was to evaluate the effectivity of current breast diagnostic methods in distinguishing between real RS, concomitant malignancy and carcinomas imitating RS. Diagnosis of RS was set up in 61 cases by mammography. Forty-four patients underwent surgical excision: histology showed benign or malignant lesions in 28 and 16 cases, respectively. A series of negative results at follow-up proved the benign nature of the lesion in further 11 cases. Six patients were not available for follow-up. Results of mammography, physical examination, ultrasonography and cytology were evaluated and were compared in 39 benign and 16 malignant cases. Results of examinations were reported on the BI-RADS scale ranging from 1 to 5. The mean categorical scores of all diagnostic processes were around the level of borderline lesions: mammography: 3.49, ultrasonography: 3.06, cytology: 2.47 and physical examination: 1.67. The average age of the patients in the benign and malignant groups were the same: 58 years. The two groups did not differ significantly over either distribution of coded mammographical results (p = 0.2092), or the distribution of mammographical parenchyma density patterns (p = 0.4875). However, the malignant and benign groups differed significantly from each other over the distribution of coded ultrasonographic (p = 0.0176) and cytological (p < 0.0001) results. In conclusion, in the preoperative diagnosis of asymptomatic "black-stars", mammography detects the non-palpable lesions, and ultrasonography together with cytology proved better in the analysis, provided FNAB is US guided. Due to the complex diagnostic approach the nature of the "black stars" is known in the majority of cases prior to the surgical biopsy.
在参加乳腺癌人群筛查的无症状女性中，放射状瘢痕（RS）的患病率为0.04%。将RS与20%-30%患者中出现的伴发恶性肿瘤或具有相似放射形态的小星状癌相鉴别很重要。我们研究的目的是评估当前乳腺诊断方法在区分真正的RS、伴发恶性肿瘤和模仿RS的癌方面的有效性。通过乳腺X线摄影确诊RS 61例。44例患者接受了手术切除：组织学检查分别显示28例为良性病变，16例为恶性病变。随访中一系列阴性结果证实另外11例病变为良性。6例患者无法进行随访。对39例良性和16例恶性病例的乳腺X线摄影、体格检查、超声检查和细胞学检查结果进行了评估和比较。检查结果按照BI-RADS分级标准报告，范围为1至5级。所有诊断过程的平均分类评分都在临界病变水平左右：乳腺X线摄影：3.49，超声检查：3.06，细胞学检查：2.47，体格检查：1.67。良性和恶性组患者的平均年龄相同：58岁。两组在编码乳腺X线摄影结果的分布（p = 0.2092）或乳腺X线摄影实质密度模式的分布（p = 0.4875）方面均无显著差异。然而，恶性组和良性组在编码超声检查结果（p = 0.0176）和细胞学检查结果（p < 0.0001）的分布上有显著差异。总之，在无症状“黑星”的术前诊断中，乳腺X线摄影可检测到不可触及的病变，超声检查和细胞学检查在分析中表现更好，前提是细针穿刺抽吸活检（FNAB）在超声引导下进行。由于采用了复杂的诊断方法，大多数病例在手术活检前就能明确“黑星”的性质。
