Division of Pathological Anatomy, Department of Medical and Surgical Critical Care, University of Florence, AOU Careggi, Viale Morgagni 85, Florence, Italy.
Breast. 2011 Jun;20(3):264-70. doi: 10.1016/j.breast.2010.12.003. Epub 2011 Jan 3.
Percutaneous core biopsy (CB) has been introduced to increase the ability of accurately diagnosing breast malignancies without the need of resorting to surgery. Compared to conventional automated 14 gauge needle core biopsy (NCB), vacuum-assisted needle core biopsy (VANCB) allows obtaining larger specimens and has recognized advantages particularly when the radiological pattern is represented by microcalcifications. Regardless of technical improvements, a small percentage of percutaneous CBs performed to detect breast lesions are still classified, according to European and UK guidelines, in the borderline B3 category, including a group of heterogeneous lesions with uncertain malignant potential. We aimed to assess the prevalence and positive predictive values (PPV) on surgical excision (SE) of B3 category (overall and by sub-categories) in a large series of non-palpable breast lesions assessed through VANCB, also comparison with published data on CB. Overall, 26,165 consecutive stereotactic VANCB were identified in 22 Italian centres: 3107 (11.9%) were classified as B3, of which 1644 (54.2%) proceeded to SE to establish a definitive histological diagnosis of breast pathology. Due to a high proportion of microcalcifications as main radiological pattern, the overall PPV was 21.2% (range 10.6%-27.3% for different B3 subtypes), somewhat lower than the average value (24.5%) from published studies (range 9.9%-35.1%). Our study, to date the largest series of B3 with definitive histological assessment on SE, suggests that B3 lesions should be referred for SE even if VANCB is more accurate than NCB in the diagnostic process of non-palpable, sonographically invisible breast lesions.
经皮核心活检（CB）的引入增加了在无需手术的情况下准确诊断乳腺恶性肿瘤的能力。与传统的自动 14 号针芯活检（NCB）相比，真空辅助针芯活检（VANCB）允许获得更大的标本，并且在放射学表现为微钙化时具有公认的优势。无论技术如何改进，根据欧洲和英国的指南，一小部分用于检测乳腺病变的经皮 CB 仍被分类为边界 B3 类别，其中包括一组具有不确定恶性潜能的异质性病变。我们旨在评估通过 VANCB 评估的大量非可触及乳腺病变中 B3 类别（总体和亚类别）的患病率和阳性预测值（PPV），并与 CB 的已发表数据进行比较。总体而言，在 22 个意大利中心确定了 26165 例连续的立体定向 VANCB：3107 例（11.9%）被分类为 B3，其中 1644 例（54.2%）进行 SE 以建立乳腺病理学的明确组织学诊断。由于主要放射学模式中微钙化的比例较高，总体 PPV 为 21.2%（不同 B3 亚型的范围为 10.6%-27.3%），略低于已发表研究的平均值（24.5%）（范围为 9.9%-35.1%）。我们的研究是迄今为止对 SE 进行明确组织学评估的最大 B3 系列研究，表明即使 VANCB 在诊断不可触及、超声不可见的乳腺病变方面比 NCB 更准确，B3 病变也应转诊进行 SE。
