Department of Radiology, European Institute of Oncology, Milan, Italy.
AJR Am J Roentgenol. 2010 Nov;195(5):1255-60. doi: 10.2214/AJR.10.4208.
The purpose of our study was to assess whether in case of total removal of microcalcifications there is still residual tumor on the surgical specimen and, secondarily, to assess whether complete rather than partial excision of the imaging target with microcalcifications may result in increased diagnostic accuracy.
We retrospectively reviewed 4,086 stereotactic vacuum-assisted breast biopsy (VABB) procedures for microcalcifications and histologic findings to determine the frequency of malignancy, histologic underestimation, and complete removal of cancer.
No residual microcalcifications on postbiopsy mammograms were seen in 1,594 of 4,047 (39.4%) procedures successfully completed: 351 of 1,594 lesions were malignant, 1,109 benign and 134 atypical. After partial removal of microcalcifications at VABB, the postsurgical specimen had infiltrating carcinoma in 130 of 566 cases (23%), whereas in case of total removal of microcalcifications, the underestimation occurred in 13 of 234 (5.5%) cases. The atypical ductal hyperplasia underestimation rate was 6.6% when the mammography target was completely removed and 38.7% when the target was only sampled. The percentage of lobular carcinoma in situ underestimation was the same for the two groups with partial and total removal of microcalcifications (21.2%). Among 1,016 VABB procedures with pathologic result of malignancy, 882 (86.6%) had residual cancer at surgery. In the group with complete removal of microcalcifications at VABB, residual cancer was found in 70% of cases.
VABB may not be considered a therapeutic procedure, even in the case of complete removal of microcalcifications. However, a complete removal of microcalcifications may result in low rates of underestimation of malignancy and may consequently increase the diagnostic accuracy of the diagnostic procedure.
本研究旨在评估在完全切除微钙化的情况下，手术标本上是否仍有残留肿瘤，其次，评估完全切除而非部分切除微钙化成像靶标是否可能提高诊断准确性。
我们回顾性分析了 4086 例立体定向真空辅助乳腺活检（VABB）用于微钙化和组织学发现的病例，以确定恶性肿瘤、组织学低估和癌症完全切除的频率。
在 4047 例成功完成的 VABB 中，术后乳腺 X 线摄影未见微钙化残留的 1594 例（39.4%）：351 例病变为恶性，1109 例良性，134 例非典型。在 VABB 部分切除微钙化后，130 例（23%）566 例手术标本中存在浸润性癌，而在完全切除微钙化的情况下，13 例（5.5%）出现低估。当完全切除乳腺 X 线摄影靶标时，非典型导管增生的低估率为 6.6%，而仅采样靶标时为 38.7%。两组微钙化部分和完全切除时，小叶原位癌的低估率相同（21.2%）。在 1016 例 VABB 病理结果为恶性的病例中，882 例（86.6%）在手术中仍有残留癌。在 VABB 完全切除微钙化的组中，70%的病例发现残留癌。
即使完全切除微钙化，VABB 也不能被视为一种治疗性手术。然而，完全切除微钙化可能会导致恶性肿瘤低估率降低，并因此提高诊断程序的诊断准确性。
