Breast Imaging Division, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110, USA.
Radiology. 2012 Nov;265(2):379-84. doi: 10.1148/radiol.12111926. Epub 2012 Sep 5.
To determine the upstage rate from nonmalignant papillary breast lesions obtained at imaging-guided core needle biopsy (CNB) and if there are any clinical, imaging, or pathologic features that can be used to predict eventual upstaging to malignancy.
This retrospective case review was institutional review board approved and HIPAA compliant, with a waiver of informed consent. A database search (from January 2001 to March 2010) was performed to find patients with a nonmalignant papillary breast lesion diagnosed at CNB. Of the resulting 128 patients, 86 (67%) underwent surgical excision; 42 (33%) patients were observed with imaging, for a median observation time of 4.1 years (range, 1.0-8.6 years). Chart review was performed to determine pertinent features of each case.
Fourteen of 128 patients were subsequently found to have malignancy at excision, for an upstage rate of 11%. Nine (7%) of the 128 patients were subsequently found to have atypia at excision. Comparisons between patients with upstaged lesions and patients whose lesions were not upstaged demonstrated patients with upstaged lesions to be slightly older (65 vs 56 years, P=.01), more likely to have a mass than calcifications at imaging (P=.03), and to have had less tissue obtained at biopsy (three vs five cores obtained, P=.02; 14- vs 9-gauge needle used, P<.01; no vacuum assistance used, P<.01). Most strongly predictive of eventual malignancy, however, was whether the interpreting pathologist qualified the benign diagnosis at CNB with additional commentary (P<.01).
Given the substantial upstage rate (11%) of papillary lesions diagnosed at imaging-guided CNB, surgical excision is an appropriate management decision; however, careful evaluation in concert with an expert breast pathologist may allow for observation in appropriately selected patients.
确定影像学引导下的核心针活检（CNB）中获得的非恶性乳头状乳腺病变的升级率，以及是否存在任何临床、影像学或病理学特征可用于预测最终升级为恶性。
本回顾性病例研究经机构审查委员会批准并符合 HIPAA 规定，豁免知情同意。对数据库（从 2001 年 1 月至 2010 年 3 月）进行搜索，寻找在 CNB 诊断为非恶性乳头状乳腺病变的患者。在 128 例患者中，86 例（67%）接受了手术切除；42 例（33%）患者接受了影像学观察，中位观察时间为 4.1 年（范围，1.0-8.6 年）。对病历进行回顾性分析，以确定每个病例的相关特征。
在切除的 128 例患者中，14 例随后被发现患有恶性肿瘤，升级率为 11%。在 128 例患者中，9 例（7%）在切除时被发现存在不典型增生。对升级病变患者和未升级病变患者进行比较，结果显示升级病变患者年龄稍大（65 岁 vs 56 岁，P=.01），影像学表现更可能为肿块而非钙化（P=.03），活检时获取的组织较少（获得 3 个 vs 5 个活检核心，P=.02；使用 14- 号 vs 9 号针，P<.01；未使用真空辅助，P<.01）。然而，最终是否发生恶性肿瘤的最有力预测因素是，在 CNB 时，解读病理学家是否对良性诊断进行了额外的评论（P<.01）。
鉴于影像学引导下 CNB 诊断的乳头状病变升级率（11%）较高，手术切除是一种合适的治疗决策；然而，与乳腺专家进行仔细评估可能允许在适当选择的患者中进行观察。
