Department of Radiology, Magee-Womens Hospital, University of Pittsburgh Medical Center, 300 Halket St, 3rd Fl, Pittsburgh, PA 15213, USA.
AJR Am J Roentgenol. 2013 Aug;201(2):439-47. doi: 10.2214/AJR.11.7693.
The purpose of this study was to determine the frequency of carcinoma identified with secondary presurgical imaging-guided percutaneous biopsy for patients with high-risk pathologic findings at primary percutaneous biopsy.
A retrospective computerized search of our breast imaging database from January 1, 2005, to October 1, 2010, was conducted to identify the cases of patients with high-risk pathologic findings at primary biopsy who underwent at least one secondary biopsy within 9 months and underwent surgical excision. Lesion type, location, biopsy guidance, device, number of samples, and histopathologic findings were recorded. The pathologic findings at surgical excision were compared with the percutaneous biopsy results.
One hundred twenty-three patients underwent 158 secondary biopsies. On average, 1.3 additional biopsies were performed per patient. Among the 158 secondary biopsies, 105 (66.4%) had benign, 48 (30.4%) had high-risk, and five (3.2%) had malignant histopathologic findings. No malignant tumors were identified at secondary percutaneous biopsies in cases in which the same lesion type was biopsied in the same quadrant. Use of secondary percutaneous biopsy led to detection of nine malignant tumors in 7.3% of patients-with percutaneous biopsy in four (3.2%) patients and at surgical excision in five (4.1%) patients.
After initial imaging-guided percutaneous biopsy reveals high-risk pathologic findings, identification of additional high-risk lesions at secondary percutaneous biopsy is common, and detection of malignancy is relatively infrequent. However, because the secondarily identified high-risk lesions are sometimes upstaged to cancer at surgical excision, additional imaging-directed biopsy has potential benefit for patients with known highrisk lesions and multiple synchronous findings.
本研究旨在确定在初次经皮穿刺活检有高危病理发现的患者中，通过二次术前影像学引导下经皮穿刺活检发现癌的频率。
对 2005 年 1 月 1 日至 2010 年 10 月 1 日的乳腺影像学数据库进行了回顾性计算机检索，以确定在初次活检有高危病理发现且在 9 个月内行至少一次二次活检并接受手术切除的患者的病例。记录病变类型、位置、活检引导、设备、样本数量和组织病理学发现。将手术切除的病理发现与经皮穿刺活检结果进行比较。
123 例患者接受了 158 次二次活检。平均每位患者进行了 1.3 次额外活检。在 158 次二次活检中，105 次（66.4%）为良性，48 次（30.4%）为高危，5 次（3.2%）为恶性组织病理学发现。在同一象限对同一病变类型进行二次经皮穿刺活检的病例中，未发现恶性肿瘤。在 7.3%的患者中，经皮活检发现了 9 例恶性肿瘤，其中 4 例（3.2%）患者为经皮活检，5 例（4.1%）患者为手术切除。
在初次影像学引导下经皮穿刺活检显示高危病理发现后，通过二次经皮穿刺活检发现额外高危病变较为常见，恶性肿瘤的检出率相对较低。然而，由于二次发现的高危病变在手术切除时有时被升级为癌症，因此对于已知高危病变和多个同步发现的患者，额外的影像学引导下活检具有潜在的益处。
