Department of Radiology, University of Washington Medical Center, Seattle, WA, USA.
AJR Am J Roentgenol. 2012 Sep;199(3):W386-91. doi: 10.2214/AJR.11.7000.
The purpose of our study was to evaluate tissue sampling methods used for MRI-detected suspicious contralateral breast lesions in the American College of Radiology Imaging Network (ACRIN) 6667 trial.
Breast MRI was performed at 25 institutions in 969 women who had a recent diagnosis of unilateral breast cancer and negative contralateral mammography and clinical breast examinations. Biopsy was recommended for MRI findings in 135 women, and 121 underwent sampling. Frequencies and positive biopsy rates of sampling methods used for initial diagnosis and imaging guidance techniques were calculated and compared.
Sampling yielded 30 malignant and 91 benign results. Initial sampling used needle biopsy in 88 of 121 (72.7%) and surgical biopsy in 30 of 121 (24.8%) women. Surgical biopsy was excisional biopsy in 28 of 30 (93.3%) and mastectomy in two of 30 (6.7%). The remaining three of 121 (2.5%) women underwent mastectomy, but it was not documented whether this represented initial tissue sampling. Of imaging-guided procedures, 56 of 106 (52.8%) used MRI; 49 of 106 (46.2%), ultrasound; and one of 106 (1.0%), stereotaxis. MRI-guided sampling was with needle biopsy rather than wire-localized surgical biopsy in 33 of 56 (58.9%) women, whereas ultrasound used needle biopsy in 47 of 49 (95.9%). Positive biopsy rates of sampling methods were 20.5% for needle biopsy, 46.2% for excisional biopsy, and 0% for mastectomy.
The majority of initial biopsies for MRI-detected contralateral breast lesions used needle biopsy rather than surgical biopsy. Contralateral surgery could have been avoided in most cases had needle biopsy been performed because most excisional biopsy and all mastectomy results were benign. MRI-guided biopsy was significantly more likely than ultrasound-guided sampling to use wire-localized surgical biopsy rather than needle biopsy.
我们的研究旨在评估美国放射学院影像网络（ACRIN）6667 试验中用于 MRI 检测到的可疑对侧乳腺病变的组织取样方法。
在 969 名最近被诊断为单侧乳腺癌且对侧乳腺 X 线摄影和临床乳房检查均为阴性的女性中，在 25 个机构进行了乳腺 MRI 检查。对于 MRI 发现，建议对 135 名女性进行活检，其中 121 名进行了取样。计算并比较了用于初始诊断和影像学引导技术的取样方法的频率和阳性活检率。
取样结果为 30 例恶性和 91 例良性。121 名女性中，88 名（72.7%）采用了针吸活检，30 名（24.8%）采用了手术活检。30 名中的 28 名（93.3%）采用了切除术活检，2 名（6.7%）采用了乳房切除术。121 名中的其余 3 名（2.5%）女性接受了乳房切除术，但没有记录这是否代表初始组织取样。在影像学引导的操作中，106 名中的 56 名（52.8%）采用了 MRI；106 名中的 49 名（46.2%）采用了超声；106 名中的 1 名（1.0%）采用了立体定位。在 56 名中的 33 名（58.9%）女性中，MRI 引导的取样采用了针吸活检而不是线定位的手术活检，而在 49 名中的 47 名（95.9%）女性中，超声采用了针吸活检。取样方法的阳性活检率为针吸活检 20.5%，切除术活检 46.2%，乳房切除术 0%。
MRI 检测到的对侧乳腺病变的初始活检大多采用了针吸活检，而不是手术活检。如果采用了针吸活检，大多数情况下可以避免对侧手术，因为大多数切除术活检和所有乳房切除术结果均为良性。与超声引导取样相比，MRI 引导活检更有可能采用线定位的手术活检而不是针吸活检。
