Senofsky G M, Davies R J, Olson L, Skully P, Olshen R
Department of Surgery, University of California, San Diego Medical Center.
Surg Gynecol Obstet. 1990 Nov;171(5):361-5.
This study was done to review critically the experience at the University of California at San Diego in needle localization mammographic biopsy of the breast with regard to use and accuracy in identifying early carcinoma of the breast. Ninety-seven patients underwent needle localization mammographic biopsy of the breast between 1985 and 1987. Indications for this procedure included the presence of microcalcifications or a mass shown on mammographic examination, or both, in conjunction with physical examination which did not define a discrete abnormality in the area. Mammographic, demographic, pathologic, hormone receptor data and staging information were recorded and processed on the MicroVax II computer (Digital Equipment Corporation). Twenty-four per cent of lesions with needle localization mammographic assisted biopsy proved to be malignant. Sixteen lesions were diagnosed as an infiltrating ductal carcinoma and ten of these had an accompanying intraductal carcinoma. Over-all, intraductal carcinoma was present in 16 of the 23 specimens diagnosed as malignant. At biopsy, the margins were clear in 17 of 23, and vascular invasion was present in only one patient with an infiltrating lobular carcinoma. Five were tumor in situ, 12 were stage 1 and five were stage 2 (staging information was not available in one instance). Hormone receptor data were available in 17 of 23 specimens. Estrogen receptors were positive in 13 and progesterone receptors were positive in six. The smallest preinvasive malignant lesion was 4 millimeters, as seen on the mammogram, and the smallest free-standing invasive lesion was 8 millimeters. Preinvasive lesions (intraductal) presented as microcalcifications in 80 per cent. Invasive lesions presented as either a mass (n = 9) or as a mass and microcalcifications (n = 5) in 81 per cent. All five lesions presenting as both a mass and microcalcifications on mammogram proved to be malignant. Multifocal lesions on mammographic examination which proved to be malignant were multifocal pathologically in only 50 per cent. Needle localization mammographic biopsy is useful in detecting early carcinoma of the breast. Biopsy should be done on lesions presenting on mammogram as both a mass and microcalcifications and not observed. Focality of lesions on mammogram does not correlate with focality on biopsy and may be misleading as criteria for operative planning.
本研究旨在严格回顾加利福尼亚大学圣地亚哥分校在乳腺针定位乳腺活检方面的经验，涉及该技术在识别早期乳腺癌中的应用及准确性。1985年至1987年间，97例患者接受了乳腺针定位乳腺活检。该操作的适应证包括乳腺X线检查显示存在微钙化或肿块，或两者兼有，且体格检查未明确该区域有离散异常。乳腺X线、人口统计学、病理、激素受体数据及分期信息均记录于MicroVax II计算机（数字设备公司）并进行处理。经针定位乳腺辅助活检的病变中，24%被证实为恶性。16个病变被诊断为浸润性导管癌，其中10个伴有导管内癌。总体而言，在23个被诊断为恶性的标本中，16个存在导管内癌。活检时，23个中有17个切缘清晰，仅1例浸润性小叶癌患者存在血管侵犯。5个为原位肿瘤，12个为1期，5个为2期（1例无分期信息）。23个标本中有17个可获得激素受体数据。13个雌激素受体阳性，6个孕激素受体阳性。乳腺X线片上可见的最小的浸润前恶性病变为4毫米，最小的独立浸润性病变为8毫米。浸润前病变（导管内癌）80%表现为微钙化。浸润性病变81%表现为肿块（n = 9）或肿块与微钙化（n = 5）。乳腺X线片上表现为肿块与微钙化的所有5个病变均被证实为恶性。乳腺X线检查显示为恶性的多灶性病变，病理上仅50%为多灶性。乳腺针定位乳腺活检有助于检测早期乳腺癌。对于乳腺X线片上表现为肿块与微钙化且未观察到的病变应进行活检。乳腺X线片上病变的局灶性与活检时的局灶性不相关，可能会误导手术规划标准。
