Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
Radiology Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
Radiol Med. 2024 Oct;129(10):1454-1462. doi: 10.1007/s11547-024-01864-1. Epub 2024 Aug 5.
To evaluate the efficacy of US-guided vacuum-assisted biopsy (US-VAB) in radiologic-pathologic (rad-path) discordance in women with suspicious breast lesions.
Two thousand three hundred and sixty patients with 2385 BI-RADS category 4 and 5 lesions underwent percutaneous US-guided CNB. Thirty-six lesions were classified as discordant benign and underwent second-line US-VAB. A 14-gauge needle was utilized for CNB and 10-gauge for US-VAB. Final pathology was the reference standard for women who underwent surgery, imaging follow-up in other cases. Rates of malignancy for US-VAB and subsequent surgery were evaluated. Lesions with upgrade and no upgrade to second-line VAB were compared in terms of patient's age, lesion type and characteristics, size and BI-RADS category. Positive predictive value (PPV), negative predictive value (NPV) for BI-RADS categories and diagnostic performance for second-line US-VAB were calculated. p value < 0.05 was considered statistically significant (t-test, Mann-Whitney, χ).
US-VAB identified 10 B2, 9 B3 and 17 B5 lesions with upgrade to malignancy of 47.2% (17/36). There were 8 invasive no special type, 7 ductal in situ, 1 invasive lobular carcinoma and 1 angiosarcoma, and their distribution among BI-RADS categories was: 2/2 in BI-RADS 5 (100%), 12/18 in BI-RADS 4C (67%) and 3/16 in BI-RADS 4B lesions (19%) (p = 0.006). Of the remaining 19 lesions, 6 underwent surgery and 2 were upgraded to ductal carcinoma in situ; 13 underwent radiological follow-up and one resulted malignant. False-negative rate for US-VAB was 15.8% (3/19) with final upgrade to malignancy of 55% (20/36). The univariate analysis revealed mass shape (p = 0.008) and BI-RADS categories (p = 0.006) to be associated with upgrade to malignancy. Sensitivity, specificity, PPV, NPV and accuracy for US-VAB were 85, 100, 100, 84 and 92%, respectively.
US-VAB identified almost 50% of cancers missed by CNB, avoiding surgical biopsies and validating as an effective mini-invasive approach in rad-path discordance.
评估在影像学-病理学（rad-path）不一致的可疑乳腺病变女性中，超声引导下真空辅助活检（US-VAB）的疗效。
对 236 例 2385 例 BI-RADS 4 和 5 类病变的患者进行了经皮超声引导下的细针穿刺活检（CNB）。36 例病变被分类为良性和二级线 US-VAB 不一致，采用 14 号活检针进行 CNB 和 10 号活检针进行 US-VAB。最终病理为手术患者的参考标准，其他病例进行影像学随访。评估了 US-VAB 和后续手术的恶性肿瘤率。比较了升级和不升级至二线 VAB 的病变在患者年龄、病变类型和特征、大小和 BI-RADS 类别方面的差异。计算了 BI-RADS 类别和二线 US-VAB 的诊断性能的阳性预测值（PPV）、阴性预测值（NPV）。p 值<0.05 被认为具有统计学意义（t 检验、Mann-Whitney、χ）。
US-VAB 发现 10 例 B2、9 例 B3 和 17 例 B5 病变，恶性升级率为 47.2%（17/36）。其中有 8 例浸润性非特殊型、7 例导管原位癌、1 例浸润性小叶癌和 1 例血管肉瘤，其在 BI-RADS 类别中的分布为：2/2 在 BI-RADS 5（100%）、12/18 在 BI-RADS 4C（67%）和 3/16 在 BI-RADS 4B 病变（19%）（p=0.006）。其余 19 例病变中，6 例行手术，2 例升级为导管原位癌；13 例行影像学随访，1 例结果为恶性。US-VAB 的假阴性率为 15.8%（3/19），最终恶性升级率为 55%（36/65）。单因素分析显示肿块形态（p=0.008）和 BI-RADS 类别（p=0.006）与恶性升级相关。US-VAB 的敏感性、特异性、PPV、NPV 和准确性分别为 85%、100%、100%、84%和 92%。
US-VAB 发现了 CNB 遗漏的近 50%的癌症，避免了手术活检，并验证了其在 rad-path 不一致中的有效微创方法。
