Department of Radiology, University of Washington Medical Center, Seattle, Wash., USA.
Radiology. 2010 Jun;255(3):723-30. doi: 10.1148/radiol.09091406. Epub 2010 Feb 19.
To determine if patients with fewer than three foci of atypical ductal hyperplasia (ADH) who have all of their calcifications removed after stereotactic 9- or 11-gauge vacuum-assisted breast biopsy (VABB) have a rate of upgrade to malignancy that is sufficiently low to obviate surgical excision.
An institutional review board-approved, HIPAA-compliant retrospective review of 991 cases of consecutive 9- or 11-gauge stereotactic VABB performed during a 65-month period revealed 147 cases of atypia. One pathologist performed a blinded review of the results of procedures performed to assess for calcifications and confirmed ADH in 101 cases with subsequent surgical excision. Each large duct or terminal duct-lobular unit containing ADH was considered a focus and counted. Postbiopsy mammograms were reviewed to determine whether all calcifications were removed. Upgrade to malignancy was determined from excisional biopsy pathology reports. Upgrade rates as a function of both number of foci and presence or absence of residual calcifications were calculated and compared by using chi(2) tests.
Upgrade to malignancy occurred in 20 (19.8%) of the 101 cases. The upgrade rate was significantly higher in cases of three or more foci of ADH (15 [28%] of 53 cases) than in cases of fewer than three foci (five [10%] of 48 cases) (P = .02). Upgrade rates were similar, regardless of whether all mammographic calcifications were removed (seven [17%] of 41 cases) or all were not removed (nine [20%] of 45 cases) (P = .77). Upgrade occurred in two (12%) of 17 cases in which there were fewer than three ADH foci and all calcifications were removed.
The upgrade rate is significantly higher when ADH involves at least three foci. Surgical excision is recommended even when ADH involves fewer than three foci and all mammographic calcifications have been removed, because the upgrade rate is 12%.
确定在立体定向 9 或 11 号活检针真空辅助乳腺活检（VABB）后，若所有钙化灶均被清除，且仅有 3 个以下不典型导管增生（ADH）病灶的患者，其恶性肿瘤升级率是否足够低，从而可以避免手术切除。
本研究为回顾性分析，经机构审查委员会批准并符合 HIPAA 规定，对 65 个月内连续进行的 9 或 11 号立体定向 VABB 共 991 例患者的资料进行分析，其中 147 例患者存在不典型病变。由同一名病理学家对评估钙化灶的检查结果进行盲法审核，并对 101 例经随后手术切除而被证实为 ADH 的患者进行确认。每个包含 ADH 的大导管或终末导管小叶单位被视为一个病灶并进行计数。对活检后的乳腺 X 线片进行评估，以确定是否所有钙化灶均被清除。从切除活检病理报告中确定恶性肿瘤升级情况。通过 χ²检验计算并比较病灶数量和钙化灶残留情况与恶性肿瘤升级率的关系。
101 例患者中，20 例（19.8%）发生恶性肿瘤升级。3 个或 3 个以上 ADH 病灶（53 例，15 例[28%]）的升级率明显高于 3 个以下病灶（48 例，5 例[10%]）（P =.02）。无论所有乳腺 X 线片上的钙化灶是否被清除（41 例，7 例[17%]）或是否全部清除（45 例，9 例[20%]），其升级率相似（P =.77）。在 3 个 ADH 病灶以下且所有钙化灶被清除的 17 例患者中，有 2 例（12%）发生恶性肿瘤升级。
当 ADH 至少涉及 3 个病灶时，其升级率明显更高。即使 ADH 病灶少于 3 个且所有乳腺 X 线片上的钙化灶已被清除，仍建议进行手术切除，因为升级率为 12%。
