Dahlstrom J E, Jain S, Sutton T, Sutton S
Department of Anatomical Pathology, Woden Valley Hospital, Canberra, Australia.
Histopathology. 1996 May;28(5):421-7. doi: 10.1046/j.1365-2559.1996.332376.x.
Stereotactic core biopsy was performed on 200 women for 206 mammographically suspicious non-palpable lesions detected over a period of 2 years as part of the Australian national programme for early detection of breast cancer. This study aimed to assess the reliability of stereotactic core biopsy in this context and to develop a protocol for the evaluation of stereotactic core biopsy in mammographically detected non-palpable breast lesions. Fifty-one of 52 malignant lesions found by stereotactic core biopsy were confirmed by excision biopsy (one women declined excision). Nine (4.5%) women had atypical ductal hyperplasia on stereotactic core biopsy; at excision, six were low grade carcinomas (in situ or invasive carcinomas), one was a 3 mm focus of grade 3 invasive duct carcinoma, one was atypical ductal hyperplasia, and one patient refused excision biopsy. In 29 (14.5%) women the histology of the stereotactic core biopsy was considered not to correlate with the radiological abnormality, and excision biopsy was advised: in four of these women carcinomas were found. One hundred and ten (55%) women had 116 benign lesions on stereotactic core biopsy: on follow-up, one of these patients has been found to have a carcinoma. Core biopsy number and sequence were analysed demonstrating that no particular biopsy was more diagnostic than any other, and that the diagnostic yield of three cores was statistically equal to that of five cores. The procedure was well-tolerated and there were few complications. Thus, stereotactic core biopsy is an accurate and safe method for diagnosis of mammographically detected non-palpable breast lesions, and we believe it is the diagnostic technique of choice in breast cancer screening programmes. However, a stereotactic core biopsy diagnosis of atypical ductal hyperplasia requires excision biopsy since a diagnosis of low grade intraduct carcinoma cannot be excluded. Furthermore, if tissue obtained by stereotactic core biopsy does not correlate with the mammographic abnormality, excision biopsy should be performed.
作为澳大利亚国家乳腺癌早期检测项目的一部分，在两年时间里，对200名女性乳房X线摄影检查发现的206个触诊阴性但可疑的病变进行了立体定向核心活检。本研究旨在评估在此背景下立体定向核心活检的可靠性，并制定一个用于评估乳房X线摄影检查发现的触诊阴性乳腺病变的立体定向核心活检方案。立体定向核心活检发现的52个恶性病变中，51个经切除活检得到证实（1名女性拒绝切除）。9名（4.5%）女性在立体定向核心活检时有非典型导管增生；切除活检时，6例为低级别癌（原位癌或浸润性癌），1例为3毫米的3级浸润性导管癌灶，1例为非典型导管增生，1例患者拒绝切除活检。29名（14.5%）女性的立体定向核心活检组织学结果被认为与放射学异常不相关，建议进行切除活检：其中4名女性发现患有癌症。110名（55%）女性在立体定向核心活检时有116个良性病变：随访中，这些患者中有1名被发现患有癌症。对活检的数量和顺序进行分析表明，没有哪种特定的活检比其他活检更具诊断性，并且3针活检的诊断率在统计学上与5针活检相等。该操作耐受性良好，并发症很少。因此，立体定向核心活检是诊断乳房X线摄影检查发现的触诊阴性乳腺病变的准确且安全的方法，我们认为它是乳腺癌筛查项目中的首选诊断技术。然而，立体定向核心活检诊断为非典型导管增生需要进行切除活检，因为不能排除低级别导管内癌的诊断。此外，如果立体定向核心活检获得的组织与乳房X线摄影异常不相关，应进行切除活检。
