乳腺芯针活检中的小叶原位肿瘤：影像学表现和病理范围可确定哪些患者需要进行切除术活检。
Lobular in-situ neoplasia on breast core needle biopsy: imaging indication and pathologic extent can identify which patients require excisional biopsy.
机构信息
Department of Anatomic Pathology, University of Washington Medical Center, Seattle, WA, USA.
出版信息
Ann Surg Oncol. 2012 Mar;19(3):914-21. doi: 10.1245/s10434-011-2034-3. Epub 2011 Aug 23.
BACKGROUND
The surgical management of lobular in-situ neoplasia (LN) identified by core needle biopsy (CNB) is currently variable. Our institution has routinely excised LN on CNB since 2003, allowing for an unbiased assessment of upgrade rates.
METHODS
Cases of LN on CNB, including atypical lobular hyperplasia (ALH) and lobular carcinoma-in-situ (LCIS), were identified in our pathology database. CNBs with concurrent pleomorphic LCIS, ductal carcinoma-in-situ (DCIS), and invasive carcinoma were excluded. Imaging indication/modality, biopsy indication, and radiologic concordance were determined. Pathology review included scoring total foci of LN in each CNB. Upgrade rates to invasive carcinoma or DCIS at excision were calculated.
RESULTS
A total of 106 cases of LN (73 ALH and 33 LCIS) on CNB were identified. Thirty patients had concurrent atypical ductal hyperplasia (ADH) and 76 had LN alone; 93 (88%) of the patients had available surgical follow-up (25 LN + ADH and 68 LN alone). The upgrade rate at excision was 16% (4 of 25) for LN + ADH and 4.4% (3 of 68) for LN alone. Patients with LN alone and discordant imaging, imaging for high-risk indications, or extensive LCIS (>4 foci) accounted for all the upgrades. Normal-risk patients who underwent biopsy to assess calcifications found by routine mammographic screening with LN alone did not result in upgrade.
CONCLUSIONS
Women with a CNB diagnosis of LN for calcifications found on routine, normal-risk mammographic screening have a negligible risk of upgrade and may not require excisional biopsy. However, excisional biopsy should be offered to women undergoing imaging for other indications or with >4 foci of LN on CNB.
背景
通过核心针活检（CNB）诊断的小叶原位肿瘤（LN）的手术处理目前存在差异。自 2003 年以来，我们医院常规对 CNB 中的 LN 进行切除，从而能够对升级率进行无偏评估。
方法
在我们的病理数据库中确定了 CNB 中的 LN 病例，包括不典型小叶增生（ALH）和小叶原位癌（LCIS）。排除了同时存在多形性 LCIS、导管原位癌（DCIS）和浸润性癌的 CNB。确定了 CNB 的影像学指征/方式、活检指征和影像学一致性。病理复查包括对每个 CNB 中 LN 的总病灶进行评分。计算切除时升级为浸润性癌或 DCIS 的发生率。
结果
共确定了 106 例 CNB 中的 LN（73 例 ALH 和 33 例 LCIS）。30 例患者同时存在不典型导管增生（ADH），76 例患者仅存在 LN；93 例（88%）患者具有可获得的手术随访（25 例 LN+ADH 和 68 例 LN 单独存在）。LN+ADH 的切除升级率为 16%（25 例中有 4 例），而 LN 单独存在的升级率为 4.4%（68 例中有 3 例）。LN 单独存在且影像学不一致、影像学具有高危指征或 LCIS 广泛（>4 个病灶）的患者出现了所有升级。仅因常规、低危乳腺 X 线筛查发现钙化而进行活检的 LN 单独存在的低危患者升级风险极小，可能不需要进行切除活检。然而，对于进行其他影像学检查或 CNB 中 LN 存在>4 个病灶的患者，应提供切除活检。
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