Department of Surgery, The University of Hong Kong, Hong Kong.
Department of Surgery, The University of Hong Kong, Hong Kong.
Int J Surg. 2018 Jan;49:27-31. doi: 10.1016/j.ijsu.2017.11.005. Epub 2017 Nov 13.
Due to the possibility of underestimation, surgical excision is usually offered to patients with atypical ductal hyperplasia (ADH) diagnosed with core needle biopsy (CNB). Here we review the 10-year data of patients with ADH diagnosed by CNB, aiming to identify the factors associated with under-diagnosis.
Retrospective review of database from 1st Jan 2005 to 31st Dec 2014 was performed; patients with ADH diagnosed by CNB were identified. Diagnosis upgrade rate and its risk factors were evaluated.
104 patients were found to have ADH on CNB, 101 patients received excisional biopsy while 3 patients refused operation. 34 patients had ductal carcinoma in situ (DCIS) after excision, 6 had invasive ductal carcinoma, 1 had lobular carcinoma in situ and 1 had angiosarcoma. CNB under-diagnosed up to 41.6% of malignant lesions. Breast mass on presentation and suspicious mammograms (BIRADS ≥ 4) are associated with diagnosis upgrade (P = 0.0005, 0.0001). Literature review of 39 studies between 1997 and 2017 revealed 3125 excision procedures performed for ADH diagnosed by CNB, the pooled median diagnosis upgrade rate was 25% (Range 4-54%).
We recommend excision in all patients with ADH diagnosed by CNB, especially in patients with suspicious mammographic features.
由于可能低估，对于经核心针活检（CNB）诊断为非典型导管增生（ADH）的患者，通常会提供手术切除。在此，我们回顾了 10 年来经 CNB 诊断为 ADH 的患者数据，旨在确定与诊断不足相关的因素。
回顾性分析 2005 年 1 月 1 日至 2014 年 12 月 31 日的数据库；确定经 CNB 诊断为 ADH 的患者。评估诊断升级率及其危险因素。
在 CNB 上发现 104 例 ADH 患者，101 例接受了切除术，3 例患者拒绝手术。切除后 34 例患者有导管原位癌（DCIS），6 例有浸润性导管癌，1 例有小叶原位癌，1 例有血管肉瘤。CNB 对恶性病变的误诊率高达 41.6%。就诊时的乳腺肿块和可疑乳腺 X 线片（BIRADS ≥ 4）与诊断升级相关（P=0.0005，0.0001）。对 1997 年至 2017 年间 39 项研究的文献回顾显示，3125 例因 CNB 诊断为 ADH 而行切除术，荟萃分析的诊断升级率中位数为 25%（范围 4-54%）。
我们建议对所有经 CNB 诊断为 ADH 的患者进行切除，特别是对具有可疑乳腺影像学特征的患者。
