1 Tufts University School of Medicine, Boston, MA.
AJR Am J Roentgenol. 2015 Jan;204(1):204-10. doi: 10.2214/AJR.13.11988.
The purpose of this study was to determine the frequencies of atypia and cancer at excisional biopsy of lesions with a diagnosis of mucocele-like lesion (MLL) at percutaneous breast biopsy.
Retrospective review of 9286 lesions subjected to percutaneous imaging-guided biopsy identified MLLs in 35 (0.38%) patients. Medical records, imaging studies, and histologic results were reviewed.
Of the 35 patients with core biopsy findings of MLL, 27 underwent stereotactic core needle biopsy (19 with microcalcifications, five with calcifications with an associated mass, and three with only a mass), and eight underwent ultrasound-guided core needle biopsy (four with a solid mass, three with a complex cystic mass). At core biopsy, 12 of 35 (34%) MLLs were associated with atypia (10 cases of atypical ductal hyperplasia, two of flat epithelial atypia), and 23 of 35 (66%) were benign MLL only. All 12 MLLs associated with atypia and 12 of 23 benign MLLs were surgically excised. Eleven patients did not undergo surgery, five of whom were lost to follow-up. One of the 12 (3% of the 35) MLLs associated with atypia was upgraded to DCIS. None were upgraded to invasive cancer. None of the benign MLLs were upgraded to malignancy, and findings at excision of four of the 23 (17%) benign MLLs led to a change in diagnosis to a high-risk lesion (three atypical ductal hyperplasia, one atypical lobular hyperplasia).
MLL is a rare diagnosis but is encountered in large-volume breast practices. The findings are nonspecific with a range of imaging appearances. No imaging test is reliable for differentiating MLL from other suspicious lesions or lesions with associated atypia. Surgery is clearly warranted for MLL associated with atypia at core needle biopsy because it may be upgraded to malignancy upon excision. However, if the presence of atypia at excision of benign MLL will change clinical management, then benign MLL at core needle biopsy warrants surgical excision in some cases. In patients whose treatment will not change if atypia is found at excision, close surveillance with short-interval follow-up is a reasonable alternative.
本研究旨在确定经皮乳腺活检诊断为黏液样病变（MLL）的病变行切除术时，不典型增生和癌症的发生率。
对 9286 例经皮影像引导活检的病变进行回顾性分析，发现 35 例（0.38%）患者为 MLL。回顾了病历、影像学研究和组织学结果。
在接受核心针活检发现 MLL 的 35 例患者中，27 例行立体定向核心针活检（19 例有微钙化，5 例有钙化伴相关肿块，3 例仅有肿块），8 例行超声引导核心针活检（4 例为实性肿块，3 例为复杂囊性肿块）。在核心针活检中，35 例 MLL 中有 12 例（34%）与不典型增生相关（10 例为非典型导管增生，2 例为扁平上皮不典型增生），23 例（66%）为良性 MLL 。所有与不典型增生相关的 12 例 MLL 和 23 例良性 MLL 中的 12 例均行手术切除。11 例患者未行手术，其中 5 例失访。在与不典型增生相关的 12 例 MLL 中，有 1 例（35 例的 3%）升级为 DCIS。无一例升级为浸润性癌。在 23 例良性 MLL 中，无一例升级为恶性肿瘤，对其中 4 例（23%）良性 MLL 的切除发现导致诊断改变为高危病变（3 例非典型导管增生，1 例非典型小叶增生）。
MLL 是一种罕见的诊断，但在大样本量的乳腺实践中会遇到。其表现无特异性，有多种影像学表现。没有一种影像学检查可可靠地区分 MLL 与其他可疑病变或伴有不典型增生的病变。对于在核心针活检中与不典型增生相关的 MLL，显然需要手术切除，因为切除后可能会升级为恶性肿瘤。然而，如果在良性 MLL 切除时发现不典型增生会改变临床管理，那么在某些情况下，在核心针活检中发现良性 MLL 时也需要手术切除。对于那些如果在切除时发现不典型增生则治疗方案不会改变的患者，进行短期随访的密切监测是一种合理的替代方案。
