超声引导穿刺组织病理学B3和B5a类乳腺病变的恶性潜能研究

Study of the malignant potential of histopathological category B3 and B5a lesions from percutaneous core needle biopsy process under the guidance of ultrasonography

目的探讨超声引导空芯针穿刺(CNB)组织病理学B3类和B5a类乳腺病变的恶性潜能。方法回顾性分析上海交通大学医学院附属第一人民医院2018年1月至2022年12月行CNB且手术切除的712个乳腺病灶的穿刺组织病理学结果,其中报告为B3类病变47个,B5a类病变70个。结果CNB病理学诊断为B3类病变47个,分别为非典型导管增生19个、乳头状病变17个、叶状肿瘤8个和复杂硬化病变3个。手术病理与CNB病理完全一致27个,一致率57.4%(27/47),不一致率42.6%(20/47)。其中70.0%(14/20)升级:CNB病理为非典型导管增生4个、导管内乳头状瘤2个,术后该6个病灶升级为浸润性乳腺癌(B5b);CNB病理为非典型导管增生4个、复杂硬化病变1个,术后该5个病灶升级为导管原位癌(B5a);2个CNB病理为非典型导管增生,术后升级为导管原位癌伴微浸润(B5b);1个CNB病理为交界性叶状肿瘤,术后升级为恶性叶状肿瘤(B5b)。30.0%(6/20)降级:CNB病理为非典型导管增生4个,术后降级为乳腺腺病(B2);CNB病理为非典型导管增生1个、交界性叶状肿瘤1个,术后该2个病灶降级为纤维腺瘤(B2)。CNB病理学诊断为B5a病变70个,与手术病理完全一致28个,一致率40.0%(28/70),不一致率60.0%(42/70)。不一致的42个病变均升级,升级率高达100%(42/42),其中21个升级为导管原位癌伴微浸润(B5b),21个升级为浸润性乳腺癌(B5b)。结论CNB病理学报告为B3和B5a类病变,在术后有较高的升级率建议高度重视B3和B5a类病变,尤其是非典型导管增生,应当予以手术切除,必要时行二次CNB检查。

Objective To investigate the malignant potential of histopathological class B3 and B5a lesions by ultrasound-guided core needle biopsy(CNB).Methods Retrospective analysis of the histopathological results of 712 breast lesions that successively underwent CNB process and surgical resection in the Shanghai General Hospital from January 2018 to December 2022,of which 47 lesions were reported as class B3 and 70 lesions as class B5a.Results CNB identified 47 category B3 lesions,comprising 19 cases of atypical ductal hyperplasia,17 papillary lesions,8 phyllodes tumors,and 3 complex sclerosing lesions.Of these cases,surgical pathology was in full agreement with CNB pathology in 27 instances,indicating a concordance rate of 57.4%(27/47)and an inconsistency rate of 42.6%(20/47).Out of the 20 inconsistent cases,70.0%(14/20)were upgraded based on the findings from the surgical pathology.Specifically,4 cases of atypical ductal hyperplasia and 2 cases of intraductal papilloma were upgraded to invasive breast cancer(B5b)after surgery.Among the 4 cases with puncture pathology indicating atypical ductal hyperplasia and one complex sclerosing lesion,these five lesions were upgraded to ductal carcinoma in situ(B5a)after surgery.Two puncture pathologies were diagnosed as atypical ductal hyperplasia,and these were upgraded to ductal carcinoma in situ with microinvasion(B5b)after surgery.One puncture pathology indicated a borderline phyllodes tumor,and this was upgraded to malignant phyllodes tumor(B5b)after surgery.And 30.0%(6/20)resulted in downgrade after surgery,specifically 4 cases of atypical ductal hyperplasia,which were downgraded to breast adenopathy(B2).Of these,1 puncture pathology was identified as atypical ductal hyperplasia and one as a borderline phyllodes tumor,which were both downgraded to fibroadenoma(B2).Seventy lesions were diagnosed as B5a lesions by CNB pathology,with 28 of them showing complete concurrence with the surgical pathology,a concordance rate of 40.0%(28/70),and an inconsistency rate of 60.0%(42/70).Of the 42 cases with discrepancies,all 42 were upgraded,yielding an upgrading rate of 100%(42/42).Of these,21 were upgraded to ductal carcinoma in situ with microinvasion(B5b)and 21 to invasive breast cancer(B5b).Conclusions Lesions with CNB pathology in categories B3 and B5a have a high rate of postoperative escalation.B3 and B5a lesions should be treated with considerable care,especially atypical ductal hyperplasia,which should be surgically resected,and CNB examination should be performed twice if necessary.