Wolf Ronald, Quan Glenda, Calhoun Kris, Soot Laurel, Skokan Laurie
Providence St. Vincent Medical Center, Portland, Oregon, USA.
Breast J. 2008 Sep-Oct;14(5):471-5. doi: 10.1111/j.1524-4741.2008.00624.x.
Stereotactic biopsy has proven more cost effective for biopsy of lesions associated with moderately suspicious mammograms. Data regarding selection of stereotactic biopsy (CORE) instead of excisional biopsy (EB) as the first diagnostic procedure in patients with nonpalpable breast lesions and highest suspicion breast imaging-reporting and data system (BI-RADS)-5 mammograms are sparse. Records from a regional health system radiology database were screened for mammograms associated with image-guided biopsy. A total of 182 nonpalpable BI-RADS-5 lesions were sampled in 178 patients over 5 years, using CORE or EB. Initial surgical margins, number of surgeries, time from initial procedure to last related surgical procedure, and hospital and professional charges for related admissions were compared using chi-squared, t-test, and Wilcoxon Mann-Whitney tests. A total of 108 CORE and 74 EB were performed as the first diagnostic procedure. Invasive or in situ carcinoma was diagnosed in 156 (86%) of all biopsies, 95 in CORE and 61 in EB groups. Negative margins of the first surgical procedure were more frequent in CORE (n = 70, 74%) versus EB (n = 17, 28%), p < 0.05. Use of CORE was associated with fewer total surgical procedures per lesion (1.29 +/- 0.05 versus 1.8 +/- 0.05, p < 0.05). Time of initial diagnostic procedure to final treatment did not vary significantly according to group (27 +/- 2 days versus 22 +/- 2 days, CORE versus EB). Mean charges including the diagnostic procedure and all subsequent surgeries were not different between CORE and EB groups ($10,500 +/- 300 versus $11,500 +/- 500, p = 0.08). Use of CORE as the first procedure in patients with highly suspicious mammograms is associated with improved pathologic margins and need for fewer surgical procedures than EB, and should be considered the preferred initial diagnostic approach.
对于与中度可疑乳腺钼靶相关的病变活检，立体定向活检已被证明更具成本效益。关于在不可触及乳腺病变且乳腺影像报告和数据系统（BI-RADS）-5级钼靶高度可疑的患者中，选择立体定向活检（CORE）而非切除活检（EB）作为首选诊断程序的数据较为稀少。对一个地区卫生系统放射学数据库中的记录进行筛查，以获取与影像引导活检相关的钼靶检查。在5年时间里，共对178例患者的182个不可触及的BI-RADS-5级病变进行了采样，采用CORE或EB。使用卡方检验、t检验和Wilcoxon Mann-Whitney检验比较了初始手术切缘、手术次数、从初始手术到最后一次相关手术的时间以及相关住院的医院和专业费用。作为首选诊断程序，共进行了108次CORE活检和74次EB活检。在所有活检中，156例（86%）诊断为浸润性癌或原位癌，CORE组95例，EB组61例。CORE组首次手术切缘阴性的频率更高（n = 70，74%），而EB组为（n = 17，28%），p < 0.05。每个病变使用CORE的总手术次数更少（1.29 +/- 0.05对1.8 +/- 0.05，p < 0.05）。根据分组，从初始诊断程序到最终治疗的时间没有显著差异（CORE组27 +/- 2天对EB组22 +/- 2天）。CORE组和EB组包括诊断程序和所有后续手术的平均费用没有差异（10,500 +/- 300美元对11,500 +/- 500美元，p = 0.08）。对于钼靶高度可疑的患者，将CORE作为首选程序与更好的病理切缘以及比EB更少的手术需求相关，应被视为首选的初始诊断方法。
