Al Hassan Tasneem, Delli Fraine Patrizio, El-Khoury Mona, Joseph Lawrence, Zheng Jiamin, Mesurolle Benoît
Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, Montreal, Quebec, H3H 1A1, Canada.
J Clin Ultrasound. 2013 Jan;41(1):1-9. doi: 10.1002/jcu.21993. Epub 2012 Sep 18.
To assess retrospectively the accuracy of core needle biopsy in diagnosing papillary breast lesions and evaluate the prediction of malignant papillary lesions based on sonographic features.
Review of 130 papillary lesions diagnosed on core needle biopsy (2002-2008) in 110 patients. The biopsy results were compared with final surgical pathology or evolution on imaging follow-up. Lesion size, patient age, type of biopsy needle and guidance, and length of imaging follow-up were documented. Sonographic features were retrospectively reviewed according to the BI-RADS lexicon. Morphology, not part of BI-RADS, was assessed as intraductal, intracystic, or solid.
Of the 130 papillary lesions, 6 were sampled with an 11-G vacuum-assisted needle under stereotactic guidance and the remaining 124 were sampled under US guidance with a 14-G (n = 115), 18-G (n = 8), or 10-G (n = 1) needle. Initial core needle biopsy diagnosis was benign (n = 103), showed atypia (n = 20), or malignancy (n = 7). Thirty-seven (36%) benign lesions were surgically excised and 66 (64%) were followed up. On final outcome, 10 benign lesions were upgraded to malignancy (9.7%) and 3 to atypia (3.6%). There was no significant difference in the benign, malignant, and upgraded groups with respect to size, age, or BI-RADS sonographic characteristics. None of the oval-shaped lesions nor the intraductal ones were upgraded.
Although some sonographic features could favor a benign diagnosis, when a core biopsy yields the diagnosis of a papillary lesion, surgical excision is recommended to definitely exclude malignancy.
回顾性评估粗针活检诊断乳腺乳头状病变的准确性，并基于超声特征评估恶性乳头状病变的预测情况。
回顾110例患者在2002年至2008年间经粗针活检诊断的130例乳头状病变。将活检结果与最终手术病理结果或影像随访结果进行比较。记录病变大小、患者年龄、活检针类型及引导方式以及影像随访时间。根据乳腺影像报告和数据系统（BI-RADS）词典回顾超声特征。形态学（不属于BI-RADS范畴）评估为导管内、囊内或实性。
130例乳头状病变中，6例在立体定位引导下采用11G真空辅助针取样，其余124例在超声引导下采用14G针（n = 115）、18G针（n = 8）或10G针（n = 1）取样。粗针活检初始诊断为良性（n = 103）、非典型性（n = 20）或恶性（n = 7）。37例（36%）良性病变接受手术切除，66例（64%）进行随访。最终结果显示，10例良性病变升级为恶性（9.7%），3例升级为非典型性（3.6%）。良性、恶性及升级组在大小、年龄或BI-RADS超声特征方面无显著差异。椭圆形病变和导管内病变均未升级。
尽管某些超声特征可能提示良性诊断，但当粗针活检诊断为乳头状病变时，建议手术切除以明确排除恶性病变。
