1 All authors: Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Ave W, Montreal, PQ, H3H 1A1 Canada.
AJR Am J Roentgenol. 2014 Jun;202(6):1389-94. doi: 10.2214/AJR.13.10864.
The purposes of this article were to review the mammographic and sonographic features of breast masses yielding atypical ductal hyperplasia (ADH) at sonographically guided biopsy, evaluate the surgical pathology outcome of these lesions, and determine whether clinical or imaging features can be used to predict upgrade to malignancy.
Among 6325 sonographically guided biopsies (2003- 2010) (14-gauge cores), 56 yielded the diagnosis of ADH (0.9%). Six patients were excluded (lost to follow-up). Fifty lesions were surgically excised in 45 patients. Mammographic and sonographic features were analyzed in consensus by two radiologists using the BI-RADS lexicon.
Forty-five patients (mean age, 56 years; 12 < 50 years; six with synchronous breast carcinoma) had 50 ADH lesions (median size, 0.6 cm). Surgical excision yielded malignancy in 28 cases (56% underestimation rate). Among 42 mammograms (47 lesions), 30 lesions were identified (30/47, 64%) as masses (12/30, 40%), asymmetric densities (10/30, 33%), microcalcifications (4/30, 13%), and architectural distortions (4/30, 13%). Sonographically, most lesions appeared as hypoechoic masses (64%, 30/47) with irregular shape (51%, 24/47), microlobulated margins (49%, 23/47), no posterior acoustic feature (25/47, 53%), abrupt interface (70%, 33/47), and parallel orientation (57%, 27/47). No mammographic and sonographic features were associated with malignant outcome, whereas age less than 50 years (p = 0.03) and synchronous malignancy (p = 0.03) were associated with malignant outcome.
ADH diagnosed at sonographically guided 14-gauge core needle biopsy shows a high underestimation rate. Synchronous carcinoma or age less than 50 years is associated with malignant outcome.
本文旨在回顾经超声引导活检诊断为非典型导管增生（ADH）的乳腺肿块的乳腺和超声特征，评估这些病变的手术病理结果，并确定临床或影像学特征是否可用于预测恶性肿瘤升级。
在 2003 年至 2010 年间进行的 6325 次超声引导活检（14 号活检针）中，有 56 例诊断为 ADH（0.9%）。排除 6 例失访患者。45 例患者（平均年龄 56 岁；12 例＜50 岁；6 例伴同时性乳腺癌）的 50 个 ADH 病变接受了手术切除。两位放射科医生使用 BI-RADS 词汇表对乳腺 X 线摄影和超声特征进行了共识分析。
45 例患者（平均年龄 56 岁；12 例＜50 岁；6 例伴同时性乳腺癌）有 50 个 ADH 病变（中位大小 0.6cm）。手术切除的恶性肿瘤率为 56%（低估率）。在 42 张乳腺 X 线片（47 个病变）中，有 30 个病变被识别（30/47，64%）为肿块（12/30，40%）、不对称密度（10/30，33%）、微钙化（4/30，13%）和结构扭曲（4/30，13%）。超声下，大多数病变表现为低回声肿块（64%，30/47），形状不规则（51%，24/47），边界微锯齿状（49%，23/47），无后方声影（25%，25/47），突然的界面（70%，33/47）和平行方向（57%，27/47）。没有乳腺 X 线摄影和超声特征与恶性结果相关，而年龄＜50 岁（p=0.03）和同时性恶性肿瘤（p=0.03）与恶性结果相关。
经超声引导 14 号活检针活检诊断的 ADH 存在较高的低估率。同时性癌或年龄＜50 岁与恶性结果相关。
