Kim Bong Kyun, Ahn Sung Gwe, Oh Se Jeong, Kim Hakyoung, Kang Eunyoung, Jung Yongsik, Do Byun Kyung, Lee Jina, Sun Woo Young
Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Breast Cancer. 2022 Feb;25(1):13-24. doi: 10.4048/jbc.2022.25.e2. Epub 2021 Dec 9.
Breast cancer is mainly diagnosed using core needle biopsy (CNB), although other biopsy methods, including vacuum-assisted biopsy (VAB), may also be used. We compared differences in clinical characteristics and prognoses of patients with breast cancer according to biopsy methods used for diagnosis.
A total of 98,457 patients who underwent various biopsy methods (CNB, fine-needle aspiration [FNA], VAB, and excisional biopsy) for diagnosing breast cancer were recruited. Using CNB as a reference, related clinicopathological factors and prognostic differences between biopsy methods were analyzed retrospectively using large-scale data from the Korean Breast Cancer Society Registration System. The associations between biopsy methods and clinicopathological factors were compared using multinomial logistic regression analysis, and the prognoses of patients undergoing the different biopsy methods, as breast cancer-specific survival (BCSS) and overall survival (OS), were compared using the Kaplan-Meier method and Cox proportional hazard model.
Univariate and multivariate analyses showed that unlike FNA, both VAB and excisional biopsy were significantly associated with tumor size, palpability, tumor stage, and histologic grade as relatively good prognostic factors compared to CNB. In particular, VAB showed lower odds ratios for these factors than excisional biopsy. In the univariate analysis, the prognosis of patients undergoing VAB was better than that of those undergoing CNB with respect to BCSS (hazard ratio [HR], 0.188, < 0.001) and OS (HR, 0.359; < 0.001). However, in the multivariate analysis, there were no significant prognostic differences from CNB in both BCSS and OS; differences were only evident for FNA.
In this study, we showed that the characteristics of breast cancer differed according to various biopsy methods. Although VAB is not a standard method for breast cancer diagnosis, it showed no prognostic differences to CNB.
乳腺癌主要通过粗针活检（CNB）进行诊断，不过也可使用其他活检方法，包括真空辅助活检（VAB）。我们比较了根据用于诊断的活检方法，乳腺癌患者临床特征和预后的差异。
共招募了98457例接受各种活检方法（CNB、细针穿刺抽吸活检[FNA]、VAB和切除活检）以诊断乳腺癌的患者。以CNB为参照，利用韩国乳腺癌协会登记系统的大规模数据，回顾性分析活检方法之间相关的临床病理因素和预后差异。使用多项逻辑回归分析比较活检方法与临床病理因素之间的关联，并使用Kaplan-Meier法和Cox比例风险模型比较接受不同活检方法患者的预后，即乳腺癌特异性生存（BCSS）和总生存（OS）。
单因素和多因素分析显示，与FNA不同，VAB和切除活检均与肿瘤大小、可触及性、肿瘤分期和组织学分级显著相关，与CNB相比这些是相对较好的预后因素。特别是，VAB在这些因素上的优势比低于切除活检。在单因素分析中，就BCSS（风险比[HR]，0.188，<0.001）和OS（HR，0.359；<0.001）而言，接受VAB患者的预后优于接受CNB的患者。然而，在多因素分析中，BCSS和OS与CNB均无显著预后差异；差异仅在FNA中明显。
在本研究中，我们表明乳腺癌的特征因各种活检方法而异。虽然VAB不是乳腺癌诊断的标准方法，但它与CNB相比无预后差异。
