Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Shinchon-dong 134, Seodaemun-ku, Seoul 120-752, South Korea.
Radiology. 2011 Jan;258(1):81-8. doi: 10.1148/radiol.10100728. Epub 2010 Oct 22.
To evaluate the diagnostic accuracy of ultrasonographically (US)-guided 14-gauge core-needle biopsy (CNB) for benign papilloma without atypia and to determine whether clinical and radiologic features could be used to predict an upgrade to malignancy.
This was an institutional review board-approved retrospective study, with a waiver of informed consent. The histologic results of US-guided CNB procedures performed from January 2006 through January 2009 were reviewed. A total of 160 benign papillomas without atypia that were diagnosed at CNB and excised surgically in 143 women (age range, 19-77 years) were assessed. Medical records and sonograms in the women were reviewed. Two radiologists working in consensus correlated imaging findings with the biopsy result to determine concordance. For the upgrade to malignancy after excision, malignant lesions were compared with nonmalignant lesions for the collected clinical and radiologic variables, which included patient age, lesion size, and lesion distance from the nipple, by using the χ(2) or Fisher exact test for categoric variables and the Mann-Whitney U test for continuous variables.
Eight (5.0%) of 160 papillomas were upgraded to malignancy. Lesions that were 1 cm or larger (seven [11%] of 63) showed a higher upgrade rate than lesions that were smaller than 1 cm (one [1%] of 97) (P = .006). The upgrade rate was higher in patients aged 50 years or older (six [16%] of 37) than in patients younger than 50 years (two [2%] of 123) (P = .002). Lesions that were 3 cm or farther from the nipple (four [13%] of 31) showed a higher upgrade rate than lesions that were less than 3 cm from the nipple (four [3.1%] of 129) (P = .046). Upgrade rates for Breast Imaging Reporting and Data System (BI-RADS) category 3, 4a, 4b, 4c, and 5 lesions were 0%, 2.5%, 6%, 27%, and 25%, respectively (P = .010).
At US-guided 14-gauge CNB, benign papilloma without atypia could be diagnosed accurately. Discordance between imaging and pathology results, as well as patient age of 50 years or older, lesion size of 1 cm or greater, lesion distance from the nipple of 3 cm or greater, and BI-RADS category may be helpful in predicting the possibility of upgrade to malignancy.
评估超声引导下 14 号针芯活检（CNB）对无非典型性良性乳突状瘤的诊断准确性，并确定临床和影像学特征是否可用于预测恶变升级。
这是一项经机构审查委员会批准的回顾性研究，豁免了知情同意。回顾了 2006 年 1 月至 2009 年 1 月期间进行的超声引导 CNB 手术的组织学结果。评估了 143 名女性（年龄 19-77 岁）共 160 例经 CNB 诊断为良性、无非典型性乳突状瘤并经手术切除的病例。对这些女性的病历和超声影像进行了回顾。两名放射科医生共同对影像结果与活检结果进行了评估，以确定一致性。对于切除后发生的恶变，将恶性病变与非恶性病变进行了比较，对收集的临床和影像学变量（包括患者年龄、病变大小和病变距乳头的距离）进行了分析，采用卡方检验或 Fisher 确切概率法进行分类变量分析，采用 Mann-Whitney U 检验进行连续变量分析。
160 例乳突状瘤中，8 例（5.0%）升级为恶性。1cm 或更大的病变（63 例中有 7 例[11%]）的升级率高于小于 1cm 的病变（97 例中有 1 例[1%]）（P=0.006）。50 岁及以上患者的升级率（37 例中有 6 例[16%]）高于 50 岁以下患者（123 例中有 2 例[2%]）（P=0.002）。距离乳头 3cm 或以上的病变（31 例中有 4 例[13%]）的升级率高于距离乳头小于 3cm 的病变（129 例中有 4 例[3.1%]）（P=0.046）。乳腺影像报告和数据系统（BI-RADS）类别 3、4a、4b、4c 和 5 病变的升级率分别为 0%、2.5%、6%、27%和 25%（P=0.010）。
在超声引导下 14 号针芯活检中，无非典型性良性乳突状瘤可得到准确诊断。影像学与病理学结果不符、患者年龄 50 岁及以上、病变大小 1cm 或更大、病变距乳头距离 3cm 或更大以及 BI-RADS 类别可能有助于预测恶变升级的可能性。
