Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States.
Department of Radiology and Medical Imaging, University of Virginia, United States.
Eur J Radiol. 2020 Oct;131:109237. doi: 10.1016/j.ejrad.2020.109237. Epub 2020 Aug 28.
To evaluate the surgical upgrade rate to malignancy and high-risk lesions in cases of papilloma without atypia diagnosed with imaging-guided percutaneous core needle biopsy (CNB) and to determine whether any lesion imaging features, biopsy techniques, and pathological factors can predict lesion upgrade to help guide clinical management.
Benign papillomas without atypia (n = 399) diagnosed with CNB were retrospectively reviewed. The surgical upgrade rate to malignancy or high-risk lesion (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in-situ, flat epithelial atypia and atypical papilloma) was determined. Detection modality (i.e. mammography, ultrasonography (US), magnetic resonance imaging (MRI)), lesion type and size, biopsy-guidance modality (US, stereotactic, MRI), biopsy needle size (<14 G vs ≥14 G), use of vacuum assistance, and presenting symptoms were statistically analyzed. The reference standard for evaluation of upgrade was either excision or at least 24 months of imaging follow-up. Chi Square test and Fisher exact tests were performed for categorical variables, and the Mann-Whitney-U test was used for continuous variables.
Ultrasound was the predominant biopsy modality (78.4 %, p < 0.001). Of the 399 benign papilloma lesions in 329 women, 239 (59.9 %) were excised and 93 others were followed for at least 24 months (total of 332). Of these 332 lesions, 7 (2.1 %) were upgraded to ductal carcinoma in-situ and 41 (12.3 %) to high-risk lesions at excision. Larger lesion size (≥15 mm, p = 0.009), smaller biopsy needle size (≥14 G, p = 0.027), and use of spring-loaded biopsy device (p = 0.012) were significantly associated with upgrade to atypia. Only lesion size (≥15 mm, p = 0.02) was associated with upgrade to cancer.
Upgrade to malignancy of biopsy-proven benign papillomas without atypia at the time of surgery was sufficiently low (2.1 %) to support non-operative management. Surgery may be performed for selected cases- those with larger lesion size and those whose biopsies were performed with smaller spring-loaded biopsy needles.
评估经影像学引导经皮核心针活检（CNB）诊断为无非典型性的乳头瘤病变升级为恶性或高危病变（非典型导管增生、非典型小叶增生、小叶原位癌、扁平上皮不典型和不典型乳头瘤）的手术升级率，并确定任何病变影像学特征、活检技术和病理因素是否可以预测病变升级，以帮助指导临床管理。
回顾性分析经 CNB 诊断为良性无非典型性乳头瘤（n=399）。确定恶性或高危病变（非典型导管增生、非典型小叶增生、小叶原位癌、扁平上皮不典型和不典型乳头瘤）的手术升级率。统计分析检测方式（即乳腺 X 线摄影术、超声检查（US）、磁共振成像（MRI））、病变类型和大小、活检引导方式（US、立体定向、MRI）、活检针大小（<14G 与≥14G）、使用真空辅助以及临床表现。评估升级的参考标准为切除或至少 24 个月的影像学随访。对分类变量进行卡方检验和 Fisher 确切检验，对连续变量进行 Mann-Whitney-U 检验。
超声是主要的活检方式（78.4%，p<0.001）。在 329 名女性的 399 个良性乳头瘤病变中，239 个（59.9%）被切除，其余 93 个至少随访 24 个月（共 332 个）。在这 332 个病变中，7 个（2.1%）升级为导管原位癌，41 个（12.3%）在切除时升级为高危病变。较大的病变大小（≥15mm，p=0.009）、较小的活检针大小（≥14G，p=0.027）和使用弹筒式活检装置（p=0.012）与非典型性升级显著相关。只有病变大小（≥15mm，p=0.02）与癌症升级相关。
在手术时，经活检证实的无非典型性良性乳头瘤恶性升级率足够低（2.1%），支持非手术治疗。对于那些病变较大且活检针较小的患者，可能需要进行手术。
