Brenner R J, Fajardo L, Fisher P R, Dershaw D D, Evans W P, Bassett L, Feig S, Mendelson E, Jackson V, Margolin F R
Eisenberg Keefer Breast Center, Saint John's Hospital and Health Center, Santa Monica, CA 90404, USA.
AJR Am J Roentgenol. 1996 Feb;166(2):341-6. doi: 10.2214/ajr.166.2.8553943.
The purpose of our study was to assess the degree of operator experience and the number of core biopsy samples required to achieve an accurate histologic diagnosis for each of five common mammographically defined lesions, using percutaneous core breast biopsy performed on a dedicated prone biopsy table.
A prospective multisite study was performed that involved nine institutions (academic and private) with experienced breast radiologists and the use of dedicated prone biopsy table units with digital assistance and standardized protocol. Asymptomatic women evaluated during a 2-year study period were assigned a mammographic diagnosis reported in a manner prescribed by the American College of Radiology Breast Imaging Reporting and Data System lexicon. Mammographic lesions evaluated included masses, masses with calcifications, clustered calcifications, focal asymmetries, and architectural distortions. Where histologic diagnosis was indicated, core biopsy was performed with five individual samples obtained and sequentially analyzed. Two hundred thirty patients had immediate excisional biopsy, the results of which provided the basis for a statistical analysis to compare the accuracy of each sequential core biopsy sample with surgical results. Statistical analysis was also done to ascertain the accuracy of core biopsy diagnosis as a function of operator experience.
Trends toward increasing accuracy were observed by increasing the number of core biopsies for each of five types of mammographically defined lesions, especially for clustered calcifications. Statistically significant increased accuracy was observed when the number of biopsies was increased beyond one (p = .003). Trends toward increased accuracy with more experience were observed for all lesions, especially for calcifications. Of the 230 lesions studied with immediate surgical validation, more than 80% of all lesions except clustered calcifications (75%) were diagnosed on the basis of two core biopsies; accuracy after five biopsies was 98% for masses, 91% for calcifications, 100% for masses with calcification, 100% for focal asymmetries, and 86% for architectural distortions.
Accuracy of diagnosis based on the results of percutaneous core breast biopsy improved with an increase in the number of core biopsy samples obtained for any given lesion seen on mammograms and with increased experience in performing the procedure. Five samples yielded an overall diagnostic accuracy of 97%. Familiarity with expected accuracy from this procedure for different mammographic lesions and following increased experience may assist physicians in planning patient management.
我们研究的目的是使用在专用俯卧活检台上进行的经皮乳腺粗针活检，评估操作者经验程度以及获取准确组织学诊断所需的粗针活检样本数量，以针对五种常见的乳腺钼靶检查定义的病变中的每一种情况进行评估。
进行了一项前瞻性多中心研究，涉及九个机构（学术机构和私立机构），这些机构拥有经验丰富的乳腺放射科医生，并使用配备数字辅助和标准化方案的专用俯卧活检台设备。在为期两年的研究期间接受评估的无症状女性被给予按照美国放射学会乳腺影像报告和数据系统词典规定方式报告的乳腺钼靶诊断。评估的乳腺钼靶病变包括肿块、伴有钙化的肿块、簇状钙化、局灶性不对称以及结构扭曲。在需要组织学诊断的情况下，进行粗针活检时获取五个单独样本并依次进行分析。230例患者接受了即刻切除活检，其结果为比较每个连续粗针活检样本与手术结果的准确性提供了统计分析基础。还进行了统计分析以确定粗针活检诊断的准确性作为操作者经验的函数关系。
对于五种乳腺钼靶检查定义的病变中的每一种，通过增加粗针活检的数量观察到准确性提高的趋势，特别是对于簇状钙化。当活检数量增加到超过一个时，观察到统计学上显著提高的准确性（p = 0.003）。对于所有病变，观察到随着经验增加准确性提高的趋势，特别是对于钙化。在230例接受即刻手术验证的病变中，除簇状钙化（75%）外，超过80%的所有病变基于两次粗针活检得以诊断；五次活检后的准确性对于肿块为98%，对于钙化是91%，对于伴有钙化的肿块为100%，对于局灶性不对称是100%，对于结构扭曲是86%。
基于经皮乳腺粗针活检结果的诊断准确性随着针对乳腺钼靶所见任何给定病变获取的粗针活检样本数量的增加以及操作经验的增加而提高。五个样本产生的总体诊断准确性为97%。熟悉该操作针对不同乳腺钼靶病变的预期准确性以及随着经验增加，可能有助于医生规划患者管理。
