乳腺乳头状病变超声引导活检所致病理组织学低估的分析

Underestimation of Papillary Breast Lesions at Ultrasound-guided Breast Biopsy

目的评估超声引导穿刺活检诊断乳腺乳头状病变所致病理组织学低估率。方法回顾性分析2005年4月至2012年4月在中国人民解放军总医院超声科行穿刺活检的超声可视乳腺病灶4453例,其中,经穿刺病理诊断为乳腺乳头状病变207例,随后行外科手术90例,随访大于1年者110例,失访7例。依据美国放射学会(ACR)乳腺病灶超声声像学分类(BI-RADS)及不同穿刺方法分别将穿刺活检病理结果与手术切除病理结果对比,分析乳腺乳头状病变超声引导穿刺活检的病理组织学低估率。结果 90例术前诊断为乳头状病变、随后行手术切除的病灶中,术后病理组织学低估共29例(32.2%),恶性低估22例(24.4%)。23例导管内乳头状瘤伴非典型增生的病灶中,11例(47.8%)被低估。137例穿刺病理为良性且病理影像学相符的病灶中,8例(5.8%)被低估。25例穿刺病理为良性但病理影像学不符的病灶中,10例被低估(40.0%)。18G、16G空芯针穿刺活检的组织学低估率分别为17.9%(P=0.017)、16.0%(P=0.023),均明显高于真空辅助穿刺活检的0。结论真空辅助穿刺活检诊断乳腺乳头状病变比16G及18G空芯针穿刺活检的准确性更高。对于超声引导空芯针穿刺活检病理为乳头状病变伴非典型增生或病理影像学不符的良性导管内乳头状瘤,需要进一步行真空辅助粗针穿刺活检或外科手术切除明确诊断。

Objective To evaluate the underestimation of papillary breast lesions diagnosed at ultra- sound-guided breast biopsy. Methods Totally 4453 ultrasound-guided visible breast lesions that were identified in the Department of Ultrasound, Chinese PLA General Hospital, from April 2005 to April 2012 were retrospec- tively reviewed. Of 207 papillary lesions that were detected by histologic findings of ultrasound-guided core needle biopsy （US-CNB） , 90 underwent surgical excision, 110 were followed up for at least one year, and 7 were lost to follow-up. The histological findings of the US-CNB and the findings of surgical excision were compared to ana- lyze the underestimation rates according to the Breast Imaging Reporting and Data System （BI-RADS） categories of American College of Radiology （ACR） and biopsy methods. Results Of the 90 papillary lesions underwent surgical excision, 29 （32. 2% ） were underestimated, and 22 malignant lesions were underestimated （24. 4% ）. Of the 23 papillomata with atypical ductal hyperplasia （ IDP ＋ ADH）, 11 （47.8%） were upgraded to malignant. Of the 137 benign intraductal papilloma （IDP） with concordance imaging-histologic findings, 8 lesions were underestimated （5.8%）, whereas 10 out of 25 （40. 0% ） IDP with diacordant imaging-histologic findings were underestimated. In total, 17. 9% understimation were biopsied by 18G core needle biopsy （CNB） （P = 0. 017） and 16.0% by 16G CNB （ P = 0. 023 ）, which were significantly higher than vacuum-assisted biopsy （VAB） . Conclusions VAB is more accurate than 16G or 18G CNB in detecting papillary breast lesions. For high underestimations of IDP ＋ ADH and IDP with discordant imaging-histologic findings, VAB or surgical exci- sions should be performed.