Smetherman Dana, Dydynski Philip, Jackson Paul
Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA.
Ochsner J. 2007 Fall;7(3):121-4.
Lobular intraepithelial neoplasia-atypical lobular hyperplasia and lobular carcinoma in situ-is a noninvasive breast lesion occasionally found in core needle biopsy and surgical biopsy specimens. The objective of this study is to identify the increased incidence of lobular carcinoma in situ with current stereotactic biopsy techniques.
Biopsy results from 1993 to 2004 were reviewed retrospectively. 2,940 stereotactic biopsies were performed using a 14-gauge gun-type needle; 1,807 stereotactic biopsies were performed using an 11-gauge vacuum-assisted needle; and 2,724 ultrasound-guided biopsies were performed using a 14-gauge gun-type needle.
The incidence of lobular intraepithelial neoplasia was 0.4% using the stereotactic 14-gauge technique, 0.4% using the ultrasound-guided 14-gauge technique, and 1.7% using the 11-gauge stereotactic technique. The increased rate of detection of lobular carcinoma in situ with an 11-gauge needle was statistically significant (p<.0001).
Lobular intraepithelial neoplasia is believed to be an incidental finding without specific imaging or clinical characteristics. Patients with detected lobular intraepithelial neoplasia have a significantly increased risk for subsequently developing breast cancer. Management recommendations can include no treatment, local excision, chemoprevention, and even bilateral prophylactic mastectomy. Radiologists and referring physicians need to be aware of the wide-ranging treatment recommendations, as lobular intraepithelial neoplasia is being identified more frequently.
小叶原位癌——非典型小叶增生和小叶原位癌——是一种非侵袭性乳腺病变，偶尔在粗针活检和手术活检标本中发现。本研究的目的是确定当前立体定向活检技术下小叶原位癌发病率的增加情况。
回顾性分析1993年至2004年的活检结果。使用14号枪式针进行了2940例立体定向活检；使用11号真空辅助针进行了1807例立体定向活检；使用14号枪式针进行了2724例超声引导下活检。
使用14号立体定向技术时小叶原位癌的发病率为0.4%，使用14号超声引导技术时为0.4%，使用11号立体定向技术时为1.7%。使用11号针检测小叶原位癌的增加率具有统计学意义（p<0.0001）。
小叶原位癌被认为是一种偶然发现，没有特定的影像学或临床特征。检测到小叶原位癌的患者随后发生乳腺癌的风险显著增加。管理建议可包括不治疗、局部切除、化学预防，甚至双侧预防性乳房切除术。放射科医生和转诊医生需要了解广泛的治疗建议，因为小叶原位癌的发现越来越频繁。
