Radiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
J Clin Pathol. 2011 Jan;64(1):65-8. doi: 10.1136/jcp.2010.083485. Epub 2010 Nov 20.
Traditionally, a core biopsy diagnosis of radial scar will prompt diagnostic surgery because of the risk of associated malignancy. However, in the absence of atypia, the risk of malignancy is low. The recent introduction of the mammotome device facilitates vacuum-assisted large-volume sampling of a lesion, such that a benign diagnosis may be accepted more confidently, and if the lesion has been entirely removed, it effectively becomes a therapeutic procedure. The aim of this study was to review the role of mammotome excision in the management of non-atypical radial scars in the screening population.
Screen-detected radial scars diagnosed on core biopsy between July 2004 and September 2008 were identified from pathology records. From January 2006, the mammotome device was used to excise non-atypical radial scars on core biopsy, as an alternative to surgery.
22 core biopsy samples containing radial scars without atypia were included in the study; 14 were planned for mammotome excision and eight for diagnostic surgical excision. In the mammotome group, 78% (11/14) of patients had confirmation of non-atypical radial scars and thus avoided an operation. Three of the 14 cases planned for mammotome excision required surgery; in one case, the mammotome cores contained lobular in situ neoplasia, and, in two cases, attempts to sample the lesion with the mammotome were unsuccessful. Only one of the 22 cases ultimately proved malignant. This was a case of ductal carcinoma in situ arising within a radial scar, where the patient proceeded straight to surgery in view of discordance between radiological and pathological features.
Utilisation of mammotome excision in the management of non-atypical radial scars successfully avoided surgery in 78% of eligible patients. Pathologists have an important role in selecting patients for mammotome excision by excluding the presence of atypia.
传统上，由于存在恶性肿瘤的风险，对放射状瘢痕的核心活检诊断会促使进行诊断性手术。但是，如果没有非典型性，恶性肿瘤的风险较低。最近引入的 Mammotome 设备便于对病变进行真空辅助大容量取样，从而可以更有信心地接受良性诊断，如果病变已完全切除，则实际上可将其视为一种治疗性手术。本研究的目的是回顾 Mammotome 切除术在筛查人群中非典型性放射状瘢痕管理中的作用。
从病理记录中确定了 2004 年 7 月至 2008 年 9 月期间在核心活检中诊断为放射状瘢痕的筛查人群。自 2006 年 1 月起，使用 Mammotome 设备切除核心活检中无非典型性的放射状瘢痕，作为手术的替代方法。
研究中包括 22 例含有非典型放射状瘢痕的核心活检样本；其中 14 例计划进行 Mammotome 切除术，8 例计划进行诊断性手术切除。在 Mammotome 组中，78％（11/14）的患者证实存在非典型性放射状瘢痕，从而避免了手术。在计划进行 Mammotome 切除术的 14 例病例中，有 3 例需要手术；其中一例 Mammotome 活检核心中包含小叶原位癌，另外两例则无法使用 Mammotome 取样。22 例最终只有 1 例证实为恶性。这是一例在放射状瘢痕内发生的导管原位癌，由于影像学和病理学特征之间存在差异，该患者直接选择了手术。
在非典型性放射状瘢痕的管理中使用 Mammotome 切除术可使 78％的符合条件的患者成功避免手术。病理学家通过排除非典型性的存在在为 Mammotome 切除术选择患者方面发挥了重要作用。
