Fuhrman G M, Cederbom G J, Bolton J S, King T A, Duncan J L, Champaign J L, Smetherman D H, Farr G H, Kuske R R, McKinnon W M
Department of Surgery, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121, USA.
Ann Surg. 1998 Jun;227(6):932-9. doi: 10.1097/00000658-199806000-00017.
The goal was to evaluate one institution's experience with image-guided core-needle breast biopsy (IGCNBB) and compare the pathologic results with wire-localized excisional breast biopsy (WLEBB) for patients with positive cores and the mammographic surveillance results for patients with negative cores.
IGCNBB is becoming a popular, minimally invasive alternative to WLEBB in the evaluation of patients with nonpalpable abnormalities.
This study includes all patients with nonpalpable breast imaging abnormalities evaluated by IGCNBB from July 1993 to February 1997. Patients with positive cores (atypical hyperplasia, carcinoma in situ, or invasive carcinoma) were evaluated by WLEBB. Patients with negative cores (benign histology) were followed with a standard mammographic protocol. IGCNBB results were compared with WLEBB results to determine the sensitivity and specificity for each IGCNBB pathologic diagnosis.
Of 1440 IGCNBBs performed during the study period, 1106 were classified as benign, and during surveillance follow-up only a single patient was demonstrated to have a carcinoma in the index part of the breast evaluated by IGCNBB (97.3% sensitivity, 99.7% specificity). IGCNBB demonstrated atypical hyperplasia in 72 patients, 5 of whom refused WLEBB. The remaining 67 patients were evaluated by WLEBB: nonmalignant findings were found in 31, carcinoma in situ was found in 25, and invasive carcinoma was found in 11 (100% sensitivity, 88.8% specificity). IGCNBB demonstrated carcinoma in situ in 84 patients; WLEBB confirmed carcinoma in situ in 54 and invasive carcinoma in 30 (65.4% sensitivity, 97.7% specificity). IGCNBB demonstrated invasive carcinoma in 178 patients. Three were lost to follow-up. On WLEBB, 173 of the remaining 175 had invasive carcinoma; the other 2 patients had carcinoma in situ (80.8% sensitivity, 99.8% specificity).
An IGCNBB that demonstrates atypical hyperplasia or carcinoma in situ requires WLEBB to define the extent of breast pathology. Mammographic surveillance for a patient with a benign IGCNBB is supported by nearly 100% specificity. An IGCNBB diagnosis of invasive carcinoma is also associated with nearly 100% specificity; therefore, these patients can have definitive surgical therapy, including axillary dissection or mastectomy, without waiting for the pathologic results of a WLEBB. Based on the authors' findings, IGCNBB can safely replace WLEBB in evaluating patients with nonpalpable breast abnormalities.
评估一家机构在影像引导下乳腺粗针穿刺活检（IGCNBB）方面的经验，并将病理结果与阳性穿刺结果患者的钢丝定位乳腺切除活检（WLEBB）以及阴性穿刺结果患者的乳腺钼靶监测结果进行比较。
在评估不可触及异常的患者时，IGCNBB正成为一种流行的、微创的替代WLEBB的方法。
本研究纳入了1993年7月至1997年2月期间接受IGCNBB评估的所有不可触及乳腺影像异常患者。阳性穿刺结果（非典型增生、原位癌或浸润性癌）的患者接受WLEBB评估。阴性穿刺结果（良性组织学）的患者采用标准乳腺钼靶方案进行随访。将IGCNBB结果与WLEBB结果进行比较，以确定每种IGCNBB病理诊断的敏感性和特异性。
在研究期间进行的1440例IGCNBB中，1106例被分类为良性，在随访监测期间，仅1例患者在IGCNBB评估的乳腺索引部位被证实患有癌症（敏感性97.3%，特异性99.7%）。IGCNBB在72例患者中显示非典型增生，其中5例拒绝WLEBB。其余67例患者接受WLEBB评估：31例发现非恶性结果，25例发现原位癌，11例发现浸润性癌（敏感性100%，特异性88.8%）。IGCNBB在84例患者中显示原位癌；WLEBB证实54例为原位癌，30例为浸润性癌（敏感性65.4%，特异性97.7%）。IGCNBB在178例患者中显示浸润性癌。3例失访。在WLEBB中，其余175例中的173例有浸润性癌；另外2例患者有原位癌（敏感性80.8%，特异性99.8%）。
显示非典型增生或原位癌的IGCNBB需要WLEBB来确定乳腺病变的范围。良性IGCNBB患者的乳腺钼靶监测具有近100%的特异性。IGCNBB诊断为浸润性癌也具有近100%的特异性；因此，这些患者可以接受确定性手术治疗，包括腋窝清扫或乳房切除术，而无需等待WLEBB的病理结果。基于作者的研究结果，IGCNBB在评估不可触及乳腺异常患者时可以安全地替代WLEBB。
