Gisvold J J, Goellner J R, Grant C S, Donohue J H, Sykes M W, Karsell P R, Coffey S L, Jung S H
Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905.
AJR Am J Roentgenol. 1994 Apr;162(4):815-20. doi: 10.2214/ajr.162.4.8140997.
The major objectives of this prospective study were to compare pathologic findings from stereotaxic core and excisional biopsies performed on patients with impalpable breast lesions and to compare the initial mammographic impression with the final histologic diagnosis.
All patients referred for preoperative localization of impalpable breast lesions between October 29, 1991, and January 15, 1993, were eligible for the study. If the patient and the lesion, on the basis of mammography, were considered suitable for core biopsy, the patient was asked to participate. Four hundred forty-five excisional biopsies were performed. One hundred sixty lesions were evaluated by core biopsy; for 104 of these lesions, five or more core samples were removed. Core biopsies were done with 14-gauge biopsy needles and were followed by a localization procedure. The pathologic features of core and excisional specimens were compared.
Biopsy results were compared for 93 (58%) benign and 67 (42%) malignant lesions. Of 104 lesions evaluated with at least five core specimens, 56 (54%) were benign and 48 (46%) were malignant. Results of core biopsy corresponded to those of excisional biopsy for 96% of benign lesions, 83% of malignant lesions, and 90% overall; sensitivity of core biopsy for malignant lesions was 85%. Of 56 lesions for which fewer than five core specimens were obtained, 37 (66%) were benign and 19 (34%) were malignant. Results of core biopsy corresponded to those of excisional biopsy for 81% of benign lesions, 79% of malignant lesions, and 80% overall; sensitivity of core biopsy for malignant lesions was 84%. Specificity of core biopsy for the entire series of benign lesions was 100%.
For mammographic lesions that are believed to be not malignant or not very likely malignant, stereotaxic core biopsy decreases the need for excisional biopsy.
本前瞻性研究的主要目的是比较对不可触及乳腺病变患者进行的立体定向粗针活检和切除活检的病理结果，并比较最初的乳腺钼靶印象与最终的组织学诊断。
1991年10月29日至1993年1月15日期间所有因术前定位不可触及乳腺病变而转诊的患者均符合本研究条件。如果根据乳腺钼靶检查，患者及其病变被认为适合进行粗针活检，则邀请患者参与。共进行了445例切除活检。160个病变通过粗针活检进行评估；其中104个病变取出了5个或更多粗针样本。使用14号活检针进行粗针活检，随后进行定位操作。比较粗针活检和切除活检标本的病理特征。
对93例（58%）良性病变和67例（42%）恶性病变的活检结果进行了比较。在104个用至少5个粗针样本评估的病变中，56个（54%）为良性，48个（46%）为恶性。粗针活检结果与切除活检结果相符的良性病变占96%，恶性病变占83%，总体占90%；粗针活检对恶性病变的敏感性为85%。在56个获取粗针样本少于5个的病变中，37个（66%）为良性，19个（34%）为恶性。粗针活检结果与切除活检结果相符的良性病变占81%，恶性病变占79%，总体占80%；粗针活检对恶性病变的敏感性为84%。整个系列良性病变粗针活检的特异性为100%。
对于乳腺钼靶检查认为不是恶性或不太可能是恶性的病变，立体定向粗针活检减少了切除活检的必要性。
