Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
Can Assoc Radiol J. 2012 May;63(2):146-52. doi: 10.1016/j.carj.2010.10.002. Epub 2011 May 10.
To compare the underestimation of ductal carcinoma in situ (DCIS) vs DCIS with "possible invasion" at breast biopsy and to determine if any factors related to clinical indication, imaging abnormality, biopsy, or DCIS-grade affected the likelihood of underestimation.
Of 3836 consecutive lesions that were biopsied by using a 14-gauge needle, 117 lesions revealed DCIS. Surgical pathology results of invasive carcinoma were compared with needle biopsy results of DCIS or DCIS with possible invasion. Clinical indication, imaging abnormality, biopsy guidance modality, sample number, and histologic grade were recorded. Yates corrected χ(2) and Fisher exact tests were used to determine differences between groups.
A total of 101 lesions were DCIS and 16 were DCIS with possible invasion at biopsy. Thirty-six of 117 lesions (31%) revealed invasive carcinoma at resection pathology. Invasive carcinoma was present more often when DCIS with possible invasion was diagnosed compared with pure DCIS (7/16 [44%] vs 29/101 [29%], P = .36). No factor, including clinical indication, imaging abnormality, biopsy guidance method, sample number, or grade, was found to significantly affect the likelihood of underestimation for lesions diagnosed as DCIS vs DCIS with "possible invasion." The likelihood of pure DCIS underestimation significantly increased when lesions were high grade compared with either intermediate or low grade (18/44 [41%] vs 9/44 [21%] vs 2/10 [20%], P = .03).
For lesions biopsied by using a 14-gauge needle, there is a trend towards underestimation of the presence of invasive carcinoma when pathology reveals DCIS with possible invasion compared with pure DCIS. High-grade DCIS was significantly more likely to be underestimated.
比较在乳腺活检中，导管原位癌（DCIS）与“可能浸润”的 DCIS 的低估情况，并确定与临床指征、影像学异常、活检或 DCIS 分级相关的任何因素是否会影响低估的可能性。
在连续 3836 例使用 14 号针进行活检的病变中，117 例显示为 DCIS。将浸润性癌的手术病理结果与针吸活检的 DCIS 或“可能浸润”的 DCIS 结果进行比较。记录临床指征、影像学异常、活检引导方式、样本数量和组织学分级。使用 Yates 校正 χ²和 Fisher 确切检验来确定组间的差异。
共有 101 例病变为 DCIS，16 例为活检时“可能浸润”的 DCIS。117 例病变中有 36 例（31%）在切除病理中发现浸润性癌。与单纯 DCIS 相比，诊断为“可能浸润”的 DCIS 时更常出现浸润性癌（7/16 [44%] vs 29/101 [29%]，P =.36）。包括临床指征、影像学异常、活检引导方法、样本数量或分级在内的任何因素均未发现显著影响诊断为 DCIS 与“可能浸润”的 DCIS 病变的低估可能性。与中、低分级相比，高分级 DCIS 的低估可能性显著增加（18/44 [41%] vs 9/44 [21%] vs 2/10 [20%]，P =.03）。
对于使用 14 号针活检的病变，与单纯 DCIS 相比，当病理显示“可能浸润”的 DCIS 时，存在低估浸润性癌存在的趋势。高分级 DCIS 更有可能被低估。
