Berg W A, Jaeger B, Campassi C, Kumar D
Department of Radiology, University of Maryland School of Medicine, Baltimore 21201, USA.
AJR Am J Roentgenol. 1998 Dec;171(6):1671-8. doi: 10.2214/ajr.171.6.9843311.
Our objective was to determine the predictive value of specimen radiography for large core (14-gauge) needle biopsy of noncalcified breast masses.
Eighty-four biopsies of 83 breast masses yielded 403 specimens. Specimens showing dense material on specimen radiography were predicted to be diagnostic; specimens showing intermediate- or low-density material were predicted to be nondiagnostic. Specimen radiographic and histopathologic findings were correlated for each specimen using vital dyes to mark individual specimens.
Of the 403 specimens, 307 (76%) contained diagnostic material representative of the lesion, with a specific diagnosis achieved for 82 (99%) of 83 lesions (62 benign, 20 malignant). Of the 293 passes containing dense material, 268 (91%) proved to be diagnostic; 11 (18%) of 62 specimens containing only low-density material proved to be diagnostic. Of the 25 (9%) of 293 specimens containing radiographically dense but nondiagnostic material, 18 (72%) showed focal fibrosis and had missed the lesion; 15 (83%) of 18 such specimens were obtained in dense parenchyma. The positive predictive value of specimen radiography was 13 (100%) of 13 in fatty breasts; 77 (96%) of 80 in breasts with minimal scattered fibroglandular elements; 91 (94%) of 97 in heterogeneously dense breasts; and 35 (70%) of 50 in breasts with extremely dense parenchyma. Of the 16 lesions sampled stereotactically, specimen radiography helped assess the inadequacy of initial sampling in three (19%). In six (9%) of 68 sonographically guided biopsies, only one or two specimens could be obtained; specimen radiography helped us predict whether material was adequate for diagnosis.
Radiography of core specimens obtained from noncalcified breast masses accurately reveals the adequacy of sampling unless the breast parenchyma is extremely dense. Such immediate assessment can help ensure adequate material from lesions that are difficult to biopsy and can thereby improve the diagnostic yield of large core needle breast biopsy.
我们的目的是确定标本射线照相术对非钙化乳腺肿块粗针（14号）活检的预测价值。
对83个乳腺肿块进行84次活检，共获得403个标本。标本射线照相显示为致密物质的标本被预测为具有诊断价值；显示为中等密度或低密度物质的标本被预测为无诊断价值。使用活性染料标记每个标本，将标本射线照相结果与组织病理学结果进行关联。
在403个标本中，307个（76%）含有代表病变的诊断性物质，83个病变中的82个（99%）（62个良性，20个恶性）获得了明确诊断。在293个含有致密物质的穿刺标本中，268个（91%）被证明具有诊断价值；62个仅含有低密度物质的标本中有11个（18%）被证明具有诊断价值。在293个标本中，25个（9%）射线照相显示为致密但无诊断价值的物质，其中18个（72%）显示局灶性纤维化且未取到病变组织；18个这样的标本中有15个（83%）取自致密实质区域。标本射线照相术在脂肪型乳腺中的阳性预测值为13个中的13个（100%）；在散在少量纤维腺体成分的乳腺中为80个中的77个（96%）；在不均匀致密乳腺中为97个中的91个（94%）；在实质极度致密的乳腺中为50个中的35个（70%）。在16个立体定向取样的病变中，标本射线照相术有助于评估3个（19%）初始取样的不足。在68个超声引导下活检中，有6个（9%）仅获得一两个标本；标本射线照相术有助于我们预测所取物质是否足以用于诊断。
从非钙化乳腺肿块获取的粗针标本射线照相术能准确显示取样是否充分，除非乳腺实质极度致密。这种即时评估有助于确保从难以活检的病变中获取足够的组织，从而提高乳腺粗针活检的诊断率。
