Breast Imaging Section, Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.130B, Houston, TX, 77030, USA.
Ann Surg Oncol. 2021 Mar;28(3):1347-1355. doi: 10.1245/s10434-020-09061-w. Epub 2020 Aug 28.
The aim of this study was to determine the upgrade rate of image-guided core needle biopsy (CNB)-proven benign breast intraductal papillomas (IDPs) without atypia to high-risk benign lesions or malignancy after surgical excision.
A retrospective database search at a single institution identified 102 adult female patients with benign breast IDPs without atypia diagnosed on imaging-guided CNBs who subsequently had surgical excisions between 2011 and 2016. Patient characteristics, imaging features, biopsy techniques, and the pathology reports from imaging-guided CNBs and subsequent surgical excisions were reviewed. The upgrade rate to malignancies or high-risk benign lesions was determined at the patient level.
The upgrade rate to malignancy was 2.9% (3/102), including two cases of ductal carcinoma in situ (DCIS) and one case of microinvasive (< 1 mm) ductal carcinoma arising from DCIS. The upgrade rate to high-risk benign lesions was 7.8% (8/102), with seven cases of atypical ductal hyperplasia and one case of atypical lobular hyperplasia. A personal history of breast cancer and a larger mean lesion size were significantly associated with an upgrade to malignancy (p < 0.05).
The management of benign breast IDPs without atypia detected on imaging-guided CNBs is controversial. Our results suggest risk stratification is important in approaching these patients. Although surgical excision should be considered for all benign breast IDPs without atypia, observation with serial imaging may be appropriate in selected low-risk patients. This approach will save many women from surgeries and decrease the cost of medical care.
本研究旨在确定在影像学引导下核心针活检（CNB）证实为非典型良性乳腺导管内乳头状瘤（IDP）的患者，在外科切除后升级为高风险良性病变或恶性肿瘤的比率。
在一家机构的回顾性数据库搜索中，确定了 102 名女性患者，她们在影像学引导的 CNB 诊断为良性乳腺 IDP 而无非典型性，随后在 2011 年至 2016 年间进行了外科切除。回顾了患者特征、影像学特征、活检技术以及影像学引导的 CNB 和随后的外科切除的病理报告。在患者水平上确定了恶性肿瘤或高风险良性病变的升级率。
恶性肿瘤升级率为 2.9%（3/102），包括 2 例导管原位癌（DCIS）和 1 例由 DCIS 引起的微浸润（<1 毫米）导管癌。高风险良性病变的升级率为 7.8%（8/102），其中 7 例为非典型导管增生，1 例为非典型小叶增生。乳腺癌个人史和较大的平均病变大小与恶性肿瘤升级显著相关（p<0.05）。
影像学引导下 CNB 检测到无非典型性的良性乳腺 IDP 的处理存在争议。我们的结果表明，对这些患者进行风险分层很重要。尽管应考虑对所有无非典型性的良性乳腺 IDP 进行外科切除，但在选定的低风险患者中，通过连续影像学观察可能是合适的。这种方法将使许多女性免于手术，并降低医疗保健成本。
