Department of Gynecology, Hospital Triemli, Zurich, Switzerland.
Department of Gynecology, Hospital Zollikerberg, Zollikerberg, Switzerland.
J Cancer Res Clin Oncol. 2021 Mar;147(3):749-754. doi: 10.1007/s00432-020-03481-7. Epub 2020 Dec 7.
Ultrasound (US)-guided breast biopsy is a routine diagnostic method used to correlate imaging finding to a histological diagnosis which is still the gold standard in preoperative diagnostics. The accuracy of US-guided breast biopsies relies on a precise radiologic-histopathologic correlation, which is discussed amongst an interdisciplinary team of gynecologists, radiologists and pathologists. However, false-negative or non-diagnostic biopsy results occur. Hence, a thorough and honest discussion to clarify the reason for discrepancies and to decide the next diagnostic step between specialists of the different disciplines is warranted. In this retrospective study, we analyzed discrepant findings between imaging and pathology results on preoperative breast biopsies.
Core and vacuum-assisted breast biopsies from 232 patients were included in this study. Inclusion criteria were (1) non-diagnostic (B1) category on histology independent from imaging category and (2) histological benign (B2) category with a BIRADS 5 (Breast Imaging Reporting and Data System) rating on imaging. Histological diagnoses were retrieved from all cases. Follow-up data were available in most cases.
138 biopsies were classified as B1, 94 biopsies as B2 category. 51 of 138 B1 cases (37%) underwent re-biopsy. Re-biopsy found malignancy (B5) in 19 of 51 cases, and B3/4 (premalignant) lesions in 3 of 51 cases. All B2 cases underwent second-look imaging-diagnosis, in 57 of 94 cases (66%) consecutive direct surgery or re-biopsy. Of these, malignancy was diagnosed histologically in 26 of 57 cases (45.6%).
Determining imaging-pathology concordance after US-guided breast biopsy is essential. Discrepant cases and further diagnostic steps need to be discussed with an interdisciplinary approach.
超声（US）引导下的乳腺活检是一种常规的诊断方法，用于将影像学发现与组织学诊断相关联，而组织学诊断仍然是术前诊断的金标准。US 引导下的乳腺活检的准确性依赖于精确的放射-病理相关性，这是在妇科医生、放射科医生和病理科医生组成的跨学科团队中进行讨论的。然而，假阴性或非诊断性活检结果仍然存在。因此，需要由不同学科的专家进行彻底和诚实的讨论，以澄清差异的原因，并决定下一步的诊断步骤。在这项回顾性研究中，我们分析了术前乳腺活检中影像学和病理学结果之间的差异。
本研究纳入了 232 例患者的核心和真空辅助乳腺活检。纳入标准为（1）组织学上独立于影像学分类的非诊断性（B1）类别，和（2）组织学良性（B2）类别，影像学上为 BIRADS 5（乳腺影像报告和数据系统）评分。从所有病例中检索到组织学诊断。大多数病例都有随访数据。
138 例活检被归类为 B1 类，94 例活检为 B2 类。在 138 例 B1 病例中，有 51 例（37%）接受了再次活检。在 51 例再次活检中，发现恶性肿瘤（B5）19 例，B3/4（癌前病变）3 例。所有 B2 病例均进行了第二次影像学诊断，在 94 例中的 57 例（66%）中直接进行了手术或再次活检。在这 57 例中，有 26 例（45.6%）组织学诊断为恶性肿瘤。
确定 US 引导下乳腺活检后的影像学-病理学一致性至关重要。需要通过跨学科的方法讨论不一致的病例和进一步的诊断步骤。
