Tian Hongtian, Li Guoqiu, Zheng Jing, Ding Zhimin, Luo Yuwei, Mai Simin, Hu Jintao, Huang Zhibin, Xu Jinfeng, Wu Huaiyu, Dong Fajin
Department of Ultrasound, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University), Shenzhen, China.
Department of Thyroid and Breast Surgery, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University), Shenzhen, China.
Quant Imaging Med Surg. 2024 Dec 5;14(12):8281-8293. doi: 10.21037/qims-24-198. Epub 2024 Oct 23.
Preoperative ultrasound-guided core needle biopsy (CNB) is currently the standard procedure for managing breast illnesses. However, the differences in outcomes between CNB and surgical excision (SE) have not been thoroughly assessed. This study aimed to explore the disparities in pathological outcomes between these two procedures, using a large sample dataset.
This retrospective study consecutively included patients who underwent CNB and SE at Shenzhen People's Hospital from May 2016 to June 2023. Immunohistochemistry (IHC) was utilized to determine the status of estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor-2 (HER2), and Ki-67. Patients presenting with HER2 IHC 2+ underwent additional fluorescence in situ hybridization (FISH) examination. The cutoff value for high Ki-67 expression was established at 14%. Molecular subtypes were classified into four groups (Luminal A, Luminal B, Triple-negative, and HER2-positive) and five groups [Luminal A, Luminal B+ (HER2-positive), Luminal B- (HER2-negative), Triple-negative, and HER2-positive], based on different criteria.
A total of 4,209 patients were included in this study. Post-surgical confirmation revealed 2,410 cases as benign and 1,799 as malignant. Among the malignant cases, 334 were excluded due to either not having undergone direct surgery or having incomplete IHC results. The remaining 1,465 cases underwent IHC testing. CNB demonstrated a 97% concordance rate (CR) in diagnosing benign cases. The CRs for diagnosing invasive breast cancer (IBC) and carcinoma in situ (CIS) were 92% and 54%, respectively. ER, PgR, HER2, and Ki-67 exhibited CRs of 94%, 91%, 98%, and 84%, respectively. In the four-group classification, the overall diagnostic CR was 82%, with CRs for Luminal A, Luminal B, HER2-positive, and triple-negative breast cancer (TNBC) being 84%, 82%, 78%, and 85%, respectively. Under the five-group classification, the overall diagnostic CR was also 82%, with CRs for Luminal A, Luminal B+, Luminal B-, HER2-positive, and TNBC being 86%, 85%, 94%, 88%, and 92%, respectively.
This study demonstrates that CNB is highly accurate in differentiating benign from malignant breast lesions, particularly showing significant consistency in the diagnosis of molecular subtypes, providing a reliable reference for clinical diagnosis.
术前超声引导下的核心针穿刺活检（CNB）是目前处理乳腺疾病的标准程序。然而，CNB与手术切除（SE）之间的结果差异尚未得到充分评估。本研究旨在使用大型样本数据集探索这两种操作在病理结果上的差异。
这项回顾性研究连续纳入了2016年5月至2023年6月在深圳市人民医院接受CNB和SE的患者。采用免疫组织化学（IHC）来确定雌激素受体（ER）、孕激素受体（PgR）、人表皮生长因子受体2（HER2）和Ki-67的状态。HER2 IHC 2+的患者接受了额外的荧光原位杂交（FISH）检查。高Ki-67表达的临界值设定为14%。根据不同标准，分子亚型分为四组（Luminal A、Luminal B、三阴性和HER2阳性）和五组[Luminal A、Luminal B+（HER2阳性）、Luminal B-（HER2阴性）、三阴性和HER2阳性]。
本研究共纳入4209例患者。术后确诊2410例为良性，1799例为恶性。在恶性病例中，334例因未接受直接手术或免疫组化结果不完整而被排除。其余1465例进行了免疫组化检测。CNB在诊断良性病例方面的符合率（CR）为97%。诊断浸润性乳腺癌（IBC）和原位癌（CIS）的CR分别为92%和54%。ER、PgR、HER2和Ki-67的CR分别为94%、91%、98%和84%。在四组分类中，总体诊断CR为82%，Luminal A、Luminal B、HER2阳性和三阴性乳腺癌（TNBC）的CR分别为84%、82%、78%和85%。在五组分类下，总体诊断CR也为82%，Luminal A、Luminal B+、Luminal B-、HER2阳性和TNBC的CR分别为86%、85%、94%、88%和92%。
本研究表明，CNB在区分乳腺良性和恶性病变方面高度准确，尤其是在分子亚型诊断方面显示出显著的一致性，为临床诊断提供了可靠的参考。
