Zhou Zhi-Rui, Wang Chen-Chen, Sun Xiang-Jie, Yang Zhao-Zhi, Yu Xiao-Li, Guo Xiao-Mao
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China;; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China;; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
J Thorac Dis. 2016 Nov;8(11):3139-3151. doi: 10.21037/jtd.2016.10.109.
A retrospective analysis of diagnoses was performed in patients with phyllodes tumors of the breast (PTB) who received preoperative core needle biopsy (CNB) and had breast surgery at Fudan University Shanghai Cancer Center from January 1, 2002 to April 1, 2013. The resulting data allowed us to compare the accordance between CNB and excision diagnoses of PTB patients and evaluate the accuracy of CNB in preoperative diagnosis.
Data from 128 patients with PTB who had undergone preoperative CNB and breast surgery were retrospectively analyzed. We reviewed the medical history, clinical follow-up data, and CNB diagnostic data. A diagnostic test was used to evaluate the sensitivity and specificity of CNB in diagnosing benign, borderline, and malignant phyllodes tumors.
The accuracy of CNB for diagnosing PTB was 13.3% (17/128). Of the remaining patients, 98 (75.5% of the PTB patients) were diagnosed with fibroadenoma or fibroepithelial lesions. The sensitivity of CNB at diagnosing benign, borderline, and malignant phyllodes tumors were 4.9% (2/41), 4.2% (3/71), and 25.0% (4/16), respectively, whereas the corresponding specificity were 92.0%, 98.2%, and 100%, respectively. Some clinical features, such as large tumor size, rapid growth, or surgical history of fibroadenomas, were indicative of an increased possibility of PTB.
CNB provides a pathological basis for the preoperative diagnosis of PTB, but it has a poor accuracy and offers limited guidance for surgical decisions. Considering CNB along with multiple histologic features may improve the ability to accurately diagnose PTB. An integrated assessment using CNBs in combination with clinical data and imaging features is suggested as a reliable strategy to assist PTB diagnosis.
对2002年1月1日至2013年4月1日期间在复旦大学附属肿瘤医院接受术前粗针穿刺活检（CNB）并进行乳腺手术的乳腺叶状肿瘤（PTB）患者的诊断进行回顾性分析。所得数据使我们能够比较PTB患者CNB诊断与切除诊断之间的一致性，并评估CNB在术前诊断中的准确性。
对128例接受术前CNB和乳腺手术的PTB患者的数据进行回顾性分析。我们回顾了病史、临床随访数据和CNB诊断数据。采用诊断试验评估CNB诊断良性、交界性和恶性叶状肿瘤的敏感性和特异性。
CNB诊断PTB的准确率为13.3%（17/128）。其余患者中，98例（占PTB患者的75.5%）被诊断为纤维腺瘤或纤维上皮性病变。CNB诊断良性、交界性和恶性叶状肿瘤的敏感性分别为4.9%（2/41）、4.2%（3/71）和25.0%（4/16），而相应的特异性分别为92.0%、98.2%和100%。一些临床特征，如肿瘤体积大、生长迅速或有纤维腺瘤手术史，提示PTB的可能性增加。
CNB为PTB的术前诊断提供了病理依据，但准确性较差，对手术决策的指导有限。综合考虑CNB和多种组织学特征可能会提高准确诊断PTB的能力。建议将CNB与临床数据和影像学特征相结合进行综合评估，作为辅助PTB诊断的可靠策略。
