110 例触诊阴性 BI-RADS 类别 4C 和 5 类的良性乳腺病变的超声、细胞学和组织学特征的相关性。居里研究所的经验。
Correlation of ultrasound, cytological, and histological features of 110 benign BI-RADS categories 4C and 5 nonpalpable breast lesions. The Institut Curie's experience.
机构信息
Department of Radiology, Institut Curie, Paris, France.
Department of Surgical Oncology, Institut Curie, Paris, France.
出版信息
Cancer Cytopathol. 2021 Jun;129(6):479-488. doi: 10.1002/cncy.22402. Epub 2021 Mar 10.
BACKGROUND
The purpose of this study was to determine the pathological and ultrasound (US) features of benign nonpalpable breast lesions (NPBLs) classified as Breast Imaging Reporting and Data System (BI-RADS) category 4C or 5.
METHODS
Between 2003 and 2007, 849 consecutive NPBLs detected at US and classified as BI-RADS category 4C (505) or 5 (344) initially underwent US-guided fine needle aspiration (FNA) at our institution. Benign diagnoses were established according to surgical excision findings or during a minimal 6-month imaging follow-up (mean, 3.7 years [SD, 2.6 years]). US BI-RADS features were reviewed and compared retrospectively using a chi-square test for the following pathological categories: epithelial and fibrous proliferation (EFP), cystic and papillary lesion (C&P), inflammatory lesion (IL), benign tumor (BT), intramammary lymph node (ILN), intraepithelial proliferative lesion (IPL), and nonspecific morphological alteration (NMA). The performance of FNA in the diagnosis of benignity was assessed.
RESULTS
Of 849 NPBLs, 110 (12.9%) NPBLs were benign: 88 (17.4%) were BI-RADS category 4C, and 22 (6.4%) were BI-RADS category 5. Forty-four (40%) were EFPs, 21 (19%) were C&Ps, 13 (12%) were NMAs, 11 (10%) were ILs, 11 (10%) were BTs, 8 (7%) were IPLs, and 2 (2%) were ILNs. Lesion shape, US pattern distribution, and posterior features showed statistically significant differences between these categories (P < .05): 33 (75%) EFPs exhibited posterior shadowing, 18 (86%) C&Ps were homogenous, 9 (82%) ILs were heterogeneous, 11 (100%) BTs were homogeneous, 9 (82%) BTs were oval, and 6 (75%) IPLs were irregularly shaped. Of the 110 benign NPBLs, FNA diagnosis was falsely positive in 7 (6%), suspicious in 10 (9%), and benign in 90 (82%), and 3 (3%) were inadequate for diagnosis.
CONCLUSION
A diverse array of benign NPBLs can be classified as BI-RADS category 4C or 5 on US, each showing specific imaging presentations.
背景
本研究旨在确定经超声（US）检查分类为乳腺影像报告和数据系统（BI-RADS）4C 或 5 类的良性触诊阴性乳腺病变（NPBL）的病理和 US 特征。
方法
2003 年至 2007 年，我院对 849 例经 US 检查且分类为 BI-RADS 4C（505 例）或 5 类（344 例）的连续 NPBL 患者进行了 US 引导下细针抽吸活检（FNA）。良性诊断依据手术切除结果或最少 6 个月的影像学随访（平均 3.7 年[SD，2.6 年]）确定。采用卡方检验对上皮和纤维性增生（EFP）、囊性和乳头状病变（C&P）、炎性病变（IL）、良性肿瘤（BT）、乳腺内淋巴结（ILN）、上皮内增生性病变（IPL）和非特异性形态改变（NMA）等病理类别进行回顾性比较。评估了 FNA 对良性病变的诊断效能。
结果
849 例 NPBL 中，110 例（12.9%）为良性：88 例（17.4%）为 BI-RADS 4C 类，22 例（6.4%）为 BI-RADS 5 类。44 例（40%）为 EFP，21 例（19%）为 C&P，13 例（12%）为 NMA，11 例（10%）为 IL，11 例（10%）为 BT，8 例（7%）为 IPL，2 例（2%）为 ILN。病变形态、US 形态分布和后方特征在这些类别之间存在统计学差异（P＜.05）：33 例（75%）EFP 表现为后方声影，18 例（86%）C&P 为均匀性，9 例（82%）IL 为不均匀性，11 例（100%）BT 为均匀性，9 例（82%）BT 为椭圆形，6 例（75%）IPL 为不规则形。在 110 例良性 NPBL 中，FNA 诊断为假阳性 7 例（6%）、可疑 10 例（9%）、良性 90 例（82%），3 例（3%）为不充分。
结论
经 US 检查，多种良性 NPBL 可分类为 BI-RADS 4C 或 5 类，每种病变均有特定的影像学表现。
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