Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365-C Clifton Rd NE, Ste C-1104, Atlanta, GA 30322.
Department of Pathology, Emory University School of Medicine, Atlanta, GA.
AJR Am J Roentgenol. 2021 Jun;216(6):1476-1485. doi: 10.2214/AJR.19.22599. Epub 2021 Apr 14.
The purpose of our study was to evaluate the upgrade rate of calcified lobular neoplasia (LN) versus incidental noncalcified classic LN found on core needle biopsy performed for the evaluation of suspicious calcifications. This retrospective study included 390 consecutive image-guided breast core needle biopsies with microcalcifications as the target that were performed between December 2009 and July 2017. In 81 of the 390 core biopsies, the highest-risk lesion was LN that then underwent either excision or imaging follow-up. Core biopsy results were compared with excision and imaging follow-up findings. An upgrade of LN was defined as ductal carcinoma in situ or invasive ductal or lobular carcinoma. Of 81 LN diagnosed on core biopsy performed for calcifications, 16 had calcifications within the LN. Fifteen of these 16 cases underwent surgical excision, and three (3/15, 20.0%) were upgraded on excision. Of the 64 core biopsies showing incidental noncalcified LN with benign concordant entities containing calcifications, 42 underwent surgical excision, and one LN (1/42, 2.4%) was upgraded. Twenty-three total lesions (one calcified LN and 22 noncalcified LN) were followed with imaging rather than excision. No cancers were detected among the follow-up group. One case was deemed to have discordant findings on radiologic-pathologic review and was sent for excision, which showed invasive cancer with tubulolobular and lobular features. Women undergoing stereotactic core needle biopsy for calcifications revealing noncalcified incidental classic LN and a benign concordant entity that could explain the presence of the target calcifications have a low risk of upgrade and may be followed with imaging. Surgical excision should be offered to women who have LN with calcifications.
我们研究的目的是评估在为可疑钙化进行的核心针活检中发现的钙化性小叶肿瘤（LN）与偶然的非钙化经典 LN 的升级率。这项回顾性研究包括 2009 年 12 月至 2017 年 7 月期间进行的 390 例连续的影像学引导乳腺核心针活检，目标是微钙化。在 390 例核心活检中，有 81 例最高风险病变为 LN，然后进行了切除或影像学随访。将核心活检结果与切除和影像学随访结果进行比较。LN 的升级定义为导管原位癌或浸润性导管或小叶癌。在 81 例因钙化而行核心活检诊断的 LN 中，有 16 例 LN 内有钙化。这 16 例中有 15 例行手术切除，其中 3 例（3/15，20.0%）在切除时升级。在 64 例显示偶然的非钙化 LN 与含有钙化的良性一致实体的核心活检中，有 42 例行手术切除，其中 1 例（1/42，2.4%）升级。23 个病变（1 个钙化 LN 和 22 个非钙化 LN）采用影像学而非手术切除进行随访。随访组未发现癌症。在放射病理学审查中，有 1 例病例被认为存在不一致的发现，并进行了切除，显示出具有管状小叶和小叶特征的浸润性癌。对因钙化而行立体定向核心针活检的女性，如果发现非钙化偶然经典 LN 与良性一致实体，且能解释靶钙化的存在，其升级风险较低，可采用影像学随访。对有钙化的 LN 女性应提供手术切除。
