乳腺扁平上皮不典型增生：病理-影像学相关性。

Flat epithelial atypia of the breast: pathological-radiological correlation.

机构信息

Cedar Breast Clinic, Department of Radiology, McGill University Health Center, Royal Victoria Hospital, 687 Pine Ave W, Montreal, PQ H3H 1A1, Canada.

出版信息

AJR Am J Roentgenol. 2011 Sep;197(3):740-6. doi: 10.2214/AJR.10.5265.

DOI:10.2214/AJR.10.5265

PMID:21862819

Abstract

OBJECTIVE

This study was undertaken to determine the prevalence of flat epithelial atypia at ultrasound-guided and stereotactically guided needle biopsies, to describe the mammographic and sonographic features of flat epithelial atypia, and to determine the significance of lesions diagnosed as flat epithelial atypia at imaging-guided needle biopsies.

MATERIALS AND METHODS

Retrospective review of a database of 1369 consecutive sonographically and stereotactically guided needle biopsies performed during a 12-month period yielded 33 lesions with flat epithelial atypia as the most severe pathologic entity (32 patients). Two radiologists retrospectively reviewed the imaging presentation, by combined consensus, according to the BI-RADS lexicon.

RESULTS

Twenty-two of 33 flat epithelial atypia diagnoses (67%) were obtained under stereotactic guidance, and 11 (33%) were obtained under sonographic guidance. Six patients had synchronous breast cancer. Flat epithelial atypia lesions presented mammographically most often as microcalcifications (20/33 [61%]) distributed in a cluster (14/20 [70%]) with amorphous morphology (13/20 [65%]). Sonographically, flat epithelial atypia lesions appeared most often as masses (9/11 [82%]), with an irregular shape (6/9 [67%]), microlobulated margins (5/9 [56%]), and hypoechoic or complex echotexture (7/9 [78%]). Twenty-eight of 33 lesions (85%) were surgically excised, confirming the flat epithelial atypia diagnosis in 11 of the 28 lesions (39%), yielding carcinoma in four (14%) and atypical ductal hyperplasia in six (21%). Columnar cell changes without atypia were diagnosed in four lesions (14%), and lobular carcinoma in situ was diagnosed in three lesions (11%).

CONCLUSION

Mammographic and sonographic presentation of flat epithelial atypia is not specific (clustered amorphous microcalcifications and irregular, hypoechoic or complex masses). Given the underestimation rate of malignancy, surgical excision should be considered when imaging-guided biopsy yields flat epithelial atypia.

摘要

目的

本研究旨在确定超声引导和立体定向引导下针活检中扁平上皮不典型的发生率，描述扁平上皮不典型的乳腺 X 线摄影和超声特征，并确定影像学引导下针活检中诊断为扁平上皮不典型的病变的意义。

材料和方法

对 12 个月内进行的 1369 例超声和立体定向引导下针活检的数据库进行回顾性分析，发现 33 例病变中扁平上皮不典型为最严重的病理实体（32 例患者）。两位放射科医生根据 BI-RADS 词汇表，通过联合共识回顾了影像学表现。

结果

33 例扁平上皮不典型诊断中有 22 例（67%）为立体定向引导下获得，11 例（33%）为超声引导下获得。6 例患者同时患有乳腺癌。扁平上皮不典型病变在乳腺 X 线摄影中最常表现为微钙化（20/33[61%]），呈簇状分布（14/20[70%]），形态呈不定形（13/20[65%]）。超声上，扁平上皮不典型病变最常表现为肿块（9/11[82%]），形态不规则（6/9[67%]），边缘呈细指状（5/9[56%]），呈低回声或复杂回声（7/9[78%]）。33 例病变中有 28 例（85%）进行了手术切除，其中 28 例病变中有 11 例（39%）证实为扁平上皮不典型，4 例（14%）为癌，6 例（21%）为非典型导管增生。4 例（14%）诊断为柱状细胞改变无不典型，3 例（11%）诊断为小叶原位癌。