乳腺病变穿刺组织病理学检查非恶性结果的处理

Management of non-malignant results in core needle biopsy of breast lesions

目的探讨芯针穿刺活检（CNB）为非恶性结果的乳腺病灶的处理策略。方法回顾性总结连续1130个CNB诊断为乳腺非恶性结果的病变，分析初次穿刺活检、切除活检或再次穿刺活检组织病理诊断和未进行再次活检者的随访资料。结果1130个经CNB诊断的非恶性病变中，530个进行再次活检，77个诊断为乳腺癌；491个随访1～38个月，平均随访时间13．3个月，发现4个乳腺癌；109个失访.CNB诊断的57．9％（22／38）的导管上皮非典型增生、22．2％（4／18）的导管上皮细胞异型性、27．9％（24／86）的乳头状病变和90．0％（9／10）可疑癌最终被诊断为乳腺癌。结论对于穿刺病理结果为高危病变的乳腺病灶应予切除活检，穿刺病理诊断与临床体检和影像学检查相符的良性病变可以考虑免除手术切除活检。

Objective To study the strategy of management of non-malignant results in core needle biopsy （CNB） of breast lesions. Methods Consecutive 2654 breast lesions underwent CNB with 14-gauge automated needles. 1130 lesions with diagnosis of non-malignant breast lesions examined by CNB were followed up. The histological diagnosis of CNB, subsequent excision or repeat CNB, and the follow-up for cases without repeat biopsy were studied. Results Among the 1130 non-malignant breast lesions examined by CNB, 530 underwent re-biopsy and 73 cases of carcinoma were found. 491 lesions were followed up for 1 -38 months （median, 13.3 months ） and another 4 cases of carcinoma were found during the follow-up. 109 cases were lost to follow-up. 57.9% （22/38） of the atypical duetal hyperplasia, 22.2% （4/18） of the atypical duetal cells, 27.9% （24/86） of the papillary lesions, and 90.0% （9/10） of the suspicious carcinoma diagnosed by CNB were re-diagnosed as breast cancer finally. Conclusions Repeat biopsy is required for the high-risk lesions diagnosed by breast CNB. Excision can be avoided on the benign lesions whose CNB diagnosis is consistent with those by physical examination and imaging.