Schwartz G F, Carter D L, Conant E F, Gannon F H, Finkel G C, Feig S A
Department of Surgery, Jefferson Medical College, Philadelphia, PA 19107-4305.
Cancer. 1994 Mar 15;73(6):1660-5. doi: 10.1002/1097-0142(19940315)73:6<1660::aid-cncr2820730618>3.0.co;2-z.
Needle-guided breast biopsy has become a regularly recommended procedure to excise nonpalpable, questionable breast lesions detected by mammography. Whether cancers detected in this manner have a more favorable outcome than those detected by clinical examination is not clearly documented.
To address questions about the biology of mammographically detected cancer and likelihood of axillary node metastasis, as well as the accuracy of screening mammography, data from 3752 needle-guided breast biopsies and 1175 nonpalpable breast cancers were reviewed.
Between 1974 and 1992, 3752 needle-guided biopsies were performed in 3441 women for nonpalpable breast lesions. Benign disease was disclosed in 2575 (68.7%) biopsies and malignancy in 1175 (31.3%). Of 1130 malignancies, 61.8% were invasive carcinomas; 4.8% were microinvasive ductal carcinomas; 28.5% were ductal carcinomas in situ; and 4.8% were lobular carcinomas in situ. Axillary dissection in 558 patients with invasive carcinoma revealed that 27.1% had at least one positive axillary node. Of patients with invasive cancers presenting as nonpalpable calcifications alone, 27.5% had at least one positive axillary node.
More than one fourth of patients with nonpalpable, invasive cancer in this series had axillary node metastasis. Therefore, axillary dissection is an important treatment consideration for all patients with invasive carcinoma, despite technique of detection. Ductal carcinomas in situ detected as limited calcifications do not require axillary dissection. In this study, 31% of biopsies proved the presence of malignancy, an acceptable and appropriate benign-to-malignant ratio.
针引导下乳腺活检已成为常规推荐的用于切除通过乳房X线摄影检测到的不可触及的、可疑乳腺病变的操作。以这种方式检测到的癌症是否比通过临床检查检测到的癌症有更有利的结果，目前尚无明确记录。
为了解决有关乳房X线摄影检测到的癌症生物学特性、腋窝淋巴结转移可能性以及乳房X线摄影筛查准确性的问题，回顾了3752例针引导下乳腺活检和1175例不可触及乳腺癌的数据。
1974年至1992年间，对3441名女性进行了3752例针引导下活检，以检查不可触及的乳腺病变。2575例（68.7%）活检显示为良性疾病，1175例（31.3%）为恶性肿瘤。在1130例恶性肿瘤中，61.8%为浸润性癌；4.8%为微浸润性导管癌；28.5%为导管原位癌；4.8%为小叶原位癌。对558例浸润性癌患者进行腋窝清扫发现，27.1%至少有一个腋窝淋巴结阳性。仅表现为不可触及钙化的浸润性癌患者中，27.5%至少有一个腋窝淋巴结阳性。
在本系列中，超过四分之一的不可触及浸润性癌患者有腋窝淋巴结转移。因此，对于所有浸润性癌患者，无论检测技术如何，腋窝清扫都是重要的治疗考虑因素。检测为局限性钙化的导管原位癌不需要腋窝清扫。在本研究中，31%的活检证实存在恶性肿瘤，这是一个可接受且合适的良性与恶性比例。
