Mailbox 4, Ninewells Medical School, Dundee DD1 9SY, UK.
Breast Unit, Level 7, Ninewells Hospital, Dundee DD1 9SY, UK.
Clin Radiol. 2020 Nov;75(11):880.e1-880.e3. doi: 10.1016/j.crad.2020.08.002. Epub 2020 Aug 26.
AIM: To assess the safety of a policy of not biopsying presumed fibroadenomas with benign ultrasound and shear-wave elastography findings in women aged 25-39 years. MATERIALS AND METHODS: Patients aged 25-39 years were included after attending a one-stop clinic before 01/05/2019 where clinical and ultrasound greyscale findings suggested a benign mass and shear-wave elastography showed a mean stiffness of <50 kPa. Such patients were reassured and discharged without biopsy or follow-up. The archived ultrasound images were reviewed subsequently by a second radiologist who could recall patients for biopsy if he deemed the imaging findings to be not definitively benign. Local and national electronic records were reviewed to identify whether these patients later re-presented with breast problems. RESULTS: Seventy-six women with a mean age of 33 years were included. The minimum follow-up was 12 months and the mean follow-up was 2 years. Three (4%) of patients were recalled after review of the ultrasound images by a second radiologist. Five (7%) patients re-presented with the same lump. Three (4%) patients re-presented with a different benign problem. Two patients presented with breast cancer in the ipsilateral breast but at a different location from the assessed benign lesion. CONCLUSION: Early audit results of a policy of not biopsying or following up clinically benign masses with benign ultrasound greyscale appearances and shear wave stiffness <50 kPa in women aged 25-39 years suggest that this approach may be safe and acceptable.
目的:评估对 25-39 岁年龄组女性中超声和剪切波弹性成像表现为良性的疑似纤维腺瘤不进行活检的政策安全性。
材料和方法:入选标准为 25-39 岁患者,于 2019 年 5 月 1 日前在一个一站式诊所就诊,临床和超声灰阶表现提示为良性肿块,剪切波弹性成像显示平均硬度<50kPa。对这些患者进行安抚并出院,无需进行活检或随访。随后由第二位放射科医生对存档的超声图像进行复查,如果他认为影像学表现不能明确为良性,则可召回患者进行活检。对局部和国家电子记录进行回顾,以确定这些患者以后是否因乳房问题再次就诊。
结果:共纳入 76 例平均年龄为 33 岁的患者。最短随访时间为 12 个月,平均随访时间为 2 年。对第二位放射科医生复查超声图像后,有 3 例(4%)患者被召回。5 例(7%)患者因同一肿块再次就诊。3 例(4%)患者因不同的良性问题再次就诊。2 例患者同侧乳房出现乳腺癌,但与评估的良性病变位于不同部位。
结论:对 25-39 岁年龄组女性中超声灰阶表现为良性且剪切波硬度<50kPa 的临床良性肿块不进行活检或随访的早期审核结果表明,这种方法可能是安全且可接受的。
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