Department of Histopathology, St Vincent's University Hospital, Dublin 4, Ireland.
J Clin Pathol. 2009 Dec;62(12):1136-40. doi: 10.1136/jcp.2009.067280.
Needle core biopsy (NCB) is a widely-used technique for non-operative evaluation of screen-detected breast lesions. Although most NCBs are B2 (benign) or B5 (malignant), some fall into the B3 category of "uncertain malignant potential". This study aims to categorise the lesions prompting a B3 NCB in the Merrion Breast Screening Unit, and establish the incidence of malignancy on subsequent excision biopsy.
Patients attending the Merrion Breast Screening Unit in Dublin between 2000 and 2008 who had a B3 NCB were identified. The NCB pathology reports were reviewed and the diagnosis correlated with excision histology; the latter was classified as benign, atypical or malignant. Lesion-specific positive predictive values (PPVs) for malignancy were derived.
141 patients with a B3 NCB were identified. The most frequent lesions on NCB were radial scar (RS; n = 57), atypical intraductal epithelial proliferation (AIDEP; n = 25) and papillary lesion (n = 24). The final diagnosis was malignant in 22 patients (16%), atypical in 40 (28%) and benign in 79 (56%). Two of the patients with a malignant diagnosis had invasive carcinoma. The lesion-specific PPVs were: lobular neoplasia 50%, AIDEP 32%, columnar cell lesion with atypia 12.5%, RS 12.3%, papillary lesion 8.3%, suspected phyllodes tumour 7.7%, and spindle cell lesion 0%. Atypia on RS NCB predicted an atypical or malignant excision diagnosis, but atypia on papillary lesion NCB did not.
One-sixth of B3 NCBs in this series proved to be malignant on excision. The PPV for malignancy varied according to lesion type.
针芯活检（NCB）是一种广泛用于非手术评估屏幕检测到的乳腺病变的技术。虽然大多数 NCB 为 B2（良性）或 B5（恶性），但有些属于 B3 类“不确定的恶性潜能”。本研究旨在对 Merrion 乳腺筛查单位中促使 B3 NCB 的病变进行分类，并确定随后切除活检的恶性肿瘤发生率。
确定 2000 年至 2008 年期间在都柏林 Merrion 乳腺筛查单位就诊并接受 B3 NCB 的患者。回顾 NCB 病理报告，并将诊断与切除组织学相关联；后者分为良性、非典型或恶性。得出病变特异性的恶性肿瘤阳性预测值（PPV）。
确定了 141 例 B3 NCB 患者。NCB 上最常见的病变是放射状瘢痕（RS；n=57）、非典型导管内上皮增生（AIDEP；n=25）和乳头状病变（n=24）。最终诊断为恶性的有 22 例（16%），非典型的有 40 例（28%），良性的有 79 例（56%）。2 例恶性诊断中有浸润性癌。病变特异性的 PPV 为：小叶肿瘤 50%、AIDEP 32%、柱状细胞病变伴非典型 12.5%、RS 12.3%、乳头状病变 8.3%、疑似叶状肿瘤 7.7%、梭形细胞病变 0%。RS NCB 的非典型性预测切除诊断为非典型或恶性，但乳头状病变 NCB 的非典型性则不能预测。
本系列中 1/6 的 B3 NCB 在切除后被证实为恶性。恶性肿瘤的 PPV 因病变类型而异。
