Marrujo G, Jolly P C, Hall M H
Am J Surg. 1986 May;151(5):599-602. doi: 10.1016/0002-9610(86)90561-1.
Screening mammography as an adjunct to physical examination led to the discovery of 237 radiographically suspicious but nonpalpable breast lesions. Needle localization of the lesion preoperatively in the mammography suite followed by breast biopsy led to the diagnosis of 64 nonpalpable carcinomas, including 25 invasive, 16 minimally invasive, and 23 noninvasive cancers. Noninvasive and minimally invasive cancers were microscopic. Of the invasive lesions, 7 were 10 mm or less in diameter and 14 were 11 to 20 mm in diameter. Noninvasive and minimally invasive cancers tended to occur in younger women (average age 52 and 51 years, respectively), and almost uniformly appeared as clustered calcifications mammographically. Invasive cancers affected an older population (average age 65 years), and the mammographic appearance was that of a mass in the majority of cases. A variety of surgical procedures were carried out subsequent to biopsy to provide definite treatment of these nonpalpable breast cancers. A review of surgical specimens available from these procedures demonstrated a 27 percent incidence of residual disease at the biopsy site. In patients who underwent mastectomy, 34 percent had an unsuspected focus of cancer in another quadrant of the breast and an additional 14 percent had an unsuspected focus of epithelial atypia. No patient with either noninvasive or minimally invasive cancer was found to have axillary lymph node metastases. Twenty-nine percent of patients with invasive tumors demonstrated lymph node metastases in the axilla. Our results demonstrate the efficacy of preoperative needle localization to assist in the biopsy of nonpalpable breast lesions and the diagnosis of a significant number of early breast cancers. The treatment plan for patients with these cancers must address the high incidence of residual disease at the biopsy site, multicentricity, and the proved capacity for invasive lesions to metastasize to the axillary lymph nodes, regardless of the size of the primary tumor.
作为体格检查辅助手段的乳腺钼靶筛查发现了237例影像学上可疑但触诊不到的乳腺病变。术前在乳腺钼靶检查室对病变进行针定位，随后进行乳腺活检，诊断出64例触诊不到的癌，包括25例浸润性癌、16例微浸润癌和23例非浸润性癌。非浸润性癌和微浸润癌为镜下所见。浸润性病变中，7例直径为10mm或更小，14例直径为11至20mm。非浸润性癌和微浸润癌倾向于发生在较年轻的女性（平均年龄分别为52岁和51岁），且在乳腺钼靶上几乎均表现为簇状钙化。浸润性癌患者年龄较大（平均年龄65岁），在大多数病例中，乳腺钼靶表现为肿块。活检后进行了多种手术操作以明确治疗这些触诊不到的乳腺癌。对这些手术获取的手术标本进行回顾显示，活检部位残留病灶的发生率为27%。接受乳房切除术的患者中，34%在乳腺的另一象限有未被怀疑的癌灶，另有14%有未被怀疑的上皮异型性病灶。未发现非浸润性癌或微浸润癌患者有腋窝淋巴结转移。29%的浸润性肿瘤患者腋窝有淋巴结转移。我们的结果表明术前针定位有助于触诊不到的乳腺病变活检及大量早期乳腺癌的诊断。对于这些癌症患者的治疗方案必须考虑活检部位残留病灶的高发生率、多中心性以及浸润性病变转移至腋窝淋巴结的能力，而无论原发肿瘤的大小。
