Ferré Romuald, Omeroglu Atilla, Mesurolle Benoît
1 Cedar Breast Clinic, McGill University Health Center, Royal Victoria Hospital, 687 Pine Ave W, Montreal, QC H3H 1A1, Canada.
2 Present address: Thunder Bay Regional Health Center, Department of Radiology, North Ontario School of Medicine, Thunder Bay, ON, Canada.
AJR Am J Roentgenol. 2017 Mar;208(3):669-675. doi: 10.2214/AJR.15.15056. Epub 2017 Jan 11.
The objective of our study was to review the sonographic features of breast lesions yielding lobular neoplasia (LN) at sonographically guided biopsy, evaluate the surgical pathology outcome of these lesions, and determine if imaging findings or clinical features can be used to predict an upgrade to malignancy.
Of the 8205 sonographically guided breast biopsies (14-gauge cores) performed from 2007 through 2014, 22 yielded a diagnosis of LN, which means that LN was the most severe pathologic lesion. Imaging features were analyzed in consensus by two radiologists. Correlation of biopsy findings with definitive pathologic results was performed when available.
Twenty-two LN lesions (20 patients [mean age ± SD, 52.05 ± 13.66 years]) were diagnosed at biopsy. Of the LN lesions that were seen on mammography (6/22, 27.3%), most lesions appeared as masses (3/6, 50%). On sonography, LN lesions (mean size, 8.10 mm) appeared as masses (15/22, 68.2%) with oval shape (10/15, 66.7%), well-circumscribed or microlobulated margins (11/15, 73.3%), hypoechoic echotexture (10/15, 66.7%), posterior enhancement (73.3%, 11/15), and parallel orientation (8/15, 53.3%). Most of the masses were categorized as BI-RADS category 4 (21/22, 95.5%). Seven lesions (7/22, 31.8%) appeared as areas of shadowing or distortion without discrete masses. Twenty (20/22, 90.9%) lesions were excised surgically, and pathology results led to an upgrade in five lesions (5/20, 25% [one nonmass lesion and four masses]). Neither mammographic nor sonographic features were associated with malignant outcome (p > 0.05).
LN diagnosed at sonographically guided 14-gauge core needle biopsy does not show any specific features according to the BI-RADS lexicon and is associated with a 25% underestimation rate. No clinical or imaging characteristic is predictive of malignancy.
本研究的目的是回顾超声引导下活检显示小叶瘤变（LN）的乳腺病变的超声特征，评估这些病变的手术病理结果，并确定影像学表现或临床特征是否可用于预测是否升级为恶性病变。
在2007年至2014年期间进行的8205例超声引导下乳腺活检（14号针芯）中，22例诊断为LN，这意味着LN是最严重的病理病变。两名放射科医生共同分析影像学特征。如有可能，将活检结果与最终病理结果进行相关性分析。
活检时诊断出22例LN病变（20例患者[平均年龄±标准差，52.05±13.66岁]）。在乳腺钼靶检查中发现的LN病变（6/22，27.3%）中，大多数病变表现为肿块（3/6，50%）。在超声检查中，LN病变（平均大小，8.10mm）表现为肿块（15/22，68.2%），呈椭圆形（10/15，66.7%），边界清晰或有微小分叶（11/15，73.3%），低回声质地（10/15，66.7%），后方增强（73.3%，11/15），以及平行方位（8/15，53.3%）。大多数肿块被归类为BI-RADS 4类（21/22，95.5%）。7例病变（7/22，31.8%）表现为阴影或变形区域，无离散肿块。20例病变（20/22，90.9%）接受了手术切除，病理结果显示5例病变升级（5/20，25%[1例非肿块病变和4例肿块]）。乳腺钼靶和超声特征均与恶性结果无关（p>0.05）。
超声引导下14号针芯活检诊断出的LN根据BI-RADS词典未显示任何特定特征，且低估率为25%。没有临床或影像学特征可预测恶性病变。
