Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York City, NY, USA.
Breast J. 2013 May-Jun;19(3):302-9. doi: 10.1111/tbj.12104. Epub 2013 Mar 28.
Focal extravasated mucin (EM) with benign or atypical epithelium is a rare finding at breast core needle biopsy (CNB) and usually prompts surgical excision to rule out mucin-producing carcinoma. In the largest detailed series to date, we assessed surgical outcomes in lesions yielding EM with atypical or nonatypical epithelium at CNB. With IRB approval, we retrospectively reviewed 28 consecutive atypical and nonatypical CNBs with EM that underwent surgical excision at our center over a 22-year period. CNB imaging and pathologic findings were concordant if pathology sufficiently explained the radiologic features of the lesions. Pathologic findings in CNB and excision specimens were correlated. Statistical analysis was performed. CNBs sampled mammographic calcifications in 25/28 (89%) women and a mass in 3/28 (11%). All cases had concordant pathologic and imaging findings. At CNB, the epithelium associated with EM was atypical in 18/28 (64%) lesions and nonatypical in 10 (36%). Cancer (one mucinous carcinoma; three ductal carcinoma in situ) was present in 4/28 excision specimens (14%; 95% confidence intervals [CI], 4%-33%). All carcinomas were in lesions with epithelial atypia at CNB (4/18; 22%; 95% CI, 6%-48%) versus none (0/10; 0%; 95% CI, 0%-31%) in nonatypical lesions at CNB; this difference was not statistically significant (p = 0.3). Surgery is warranted for lesions yielding EM with atypia at CNB due to the high (22%) prevalence of cancer. Our data suggest that surgical excision of lesions yielding EM without epithelial atypia at CNB may not be necessary provided that imaging and pathologic findings are concordant.
乳腺核心针活检（CNB）中出现局灶性外溢粘蛋白（EM）伴良性或非典型上皮是一种罕见表现，通常需要手术切除以排除产粘蛋白癌。在迄今为止最大的详细系列中，我们评估了在 CNB 中获得伴非典型或非典型上皮的 EM 的病变进行手术切除的手术结果。在获得机构审查委员会批准后，我们回顾性分析了 28 例在 22 年期间在我们中心进行手术切除的连续非典型和非典型 CNB 伴 EM 的患者。如果病理学充分解释了病变的影像学特征，则 CNB 成像和病理学发现是一致的。比较了 CNB 和切除标本的病理学发现。进行了统计学分析。在 28 例女性中，25 例（89％）的 CNB 取样乳腺钙化，3 例（11％）取样肿块。所有病例的病理学和影像学发现均一致。在 CNB 中，与 EM 相关的上皮在 18/28（64％）病变中为非典型，在 10/28（36％）病变中为非典型。在 4/28（14％；95％置信区间[CI]，4％-33％）的切除标本中存在癌症（1 例黏液癌；3 例导管原位癌）。在 CNB 上皮不典型的病变中（4/18；22％；95％CI，6％-48％）发现 4 例（4/18；22％；95％CI，6％-48％）癌症，而在 CNB 上皮非典型病变中（0/10；0％；95％CI，0％-31％）未见癌症；这种差异无统计学意义（p=0.3）。由于癌症的高（22％）患病率，对于在 CNB 中出现伴上皮不典型的 EM 的病变，需要进行手术。我们的数据表明，如果影像学和病理学发现一致，那么对于在 CNB 中获得无上皮不典型的 EM 的病变，可能不需要进行手术切除。
