Ramzi Saed, Hyett Elaine L, Wheal Abigail S, Cant Peter J
Primrose Beast Care Centre, Derriford Hospital, Plymouth, UK.
Department of Cellular & Anatomical Pathology, Derriford Hospital, Plymouth, UK.
Breast J. 2018 Jul;24(4):493-500. doi: 10.1111/tbj.13000. Epub 2018 Feb 24.
True invasive tubular breast carcinoma (TBC) is unlikely to metastasize to axillary nodes, yet it is routinely subjected to sentinel lymph node biopsy (SLNB), even if the diagnosis was suspected preoperatively. The positive predictive value (PPV) of core biopsy for TBC and the incidence and predictors of axillary metastasis in invasive breast carcinomas identified as tubular-rich on core biopsy are unknown. Prospective patient and tumor data regarding postoperatively confirmed TBCs, and tubular-rich carcinoma identified on preoperative core biopsy between January 2005 and May 2016 was analyzed retrospectively. Axillary metastasis occurred in only 4.2% (4/95) of TBCs, all of which measured >15 mm pathologically. In 11.1% (11/99) of TBCs, the initial core biopsy was either indeterminate/suspicious or ductal carcinoma in situ (DCIS); therefore, their true tubular histotype and size were ascertained following operative excision and before SLNB. Nine were ≤15 mm, and all were node-negative. Only 63.9% (46/72) of tubular-rich core biopsies were confirmed as TBCs; the remaining 36.1% (26/72) were well-differentiated invasive nontubular carcinomas. None of the preoperative patient or tumor features were predictive of true TBC on multivariable analysis; 10.1% (7/69) of carcinomas identified as tubular-rich on core biopsy (regardless of their true histotypes) were node-positive; 23.1% (6/26) in nontubular and 2.3% (1/43) in true tubular carcinomas. Preoperative ultrasound size >15 mm was associated with axillary metastasis in 40.0% (4/10) compared to 5.7% (3/53) in those ≤15 mm (OR = 11.11, 95% CI = 1.99-62.04; multivariable P = .010). Axillary metastasis in TBC is dependent on pathological size; therefore, a case is made for omitting SLNB in small true TBCs confirmed following excision. Preoperative tubular-rich core biopsy is not adequately diagnostic of TBC; however, it selects carcinomas that are well-differentiated, small, and unlikely to metastasize to the axilla, thus allowing for the selective omission of SLNB.
真正的浸润性小管癌（TBC）不太可能转移至腋窝淋巴结，但即便术前已怀疑诊断结果，它仍常规接受前哨淋巴结活检（SLNB）。对于TBC，粗针活检的阳性预测值（PPV）以及在粗针活检中被确定为富含小管的浸润性乳腺癌的腋窝转移发生率和预测因素尚不清楚。我们对2005年1月至2016年5月期间术后确诊为TBC以及术前粗针活检中确定为富含小管的癌的患者和肿瘤的前瞻性数据进行了回顾性分析。TBC中仅4.2%（4/95）发生腋窝转移，所有这些病例在病理上测量直径均>15 mm。在11.1%（11/99）的TBC中，最初的粗针活检结果为不确定/可疑或原位导管癌（DCIS）；因此，在手术切除后和SLNB之前确定了它们真正的小管组织学类型和大小。其中9例直径≤15 mm，且均无淋巴结转移。在富含小管的粗针活检中，仅63.9%（46/72）被确诊为TBC；其余36.1%（26/72）为高分化浸润性非小管癌。在多变量分析中，术前患者或肿瘤特征均不能预测真正的TBC；在粗针活检中被确定为富含小管的癌（无论其真正的组织学类型如何）中，10.1%（7/69）有淋巴结转移；在非小管癌中为23.1%（6/26），在真正的小管癌中为2.3%（1/43）。术前超声测量大小>15 mm的患者中40.0%（4/10）发生腋窝转移，而直径≤15 mm的患者中这一比例为5.7%（3/53）（OR = 11.11，95% CI = 1.99 - 62.04；多变量P = 0.010）。TBC的腋窝转移取决于病理大小；因此，对于切除后确诊的小的真正TBC病例，有理由省略SLNB。术前富含小管的粗针活检对TBC的诊断并不充分；然而，它筛选出了高分化、小且不太可能转移至腋窝的癌，从而允许选择性地省略SLNB。
