Are We Overtreating Papillomas Diagnosed on Core Needle Biopsy?
Are We Overtreating Papillomas Diagnosed on Core Needle Biopsy?
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DOI：
10.1245/s10434-010-1403-7
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发表时间：
2011-04-01
影响因子：
3.7
通讯作者：
Aft, Rebecca L.
中科院分区：
文献类型：
--
作者：
Cyr, Amy E.;Novack, Deborah;Aft, Rebecca L.
乳头状瘤通常通过空心针活检（CNB）来诊断。大多数研究支持切除非典型乳头状瘤，因为多达一半的人在最终病理学上会升级为恶性肿瘤。关于 CNB 上无异型性的乳头状瘤的治疗，文献还不太清楚。我们的目标是确定与切除病理升级相关的因素。我们的病理数据库搜索了过去 10 年中 CNB 诊断的乳头状瘤。我们在 CNB 上识别了 277 个图表并排除了与异型性或恶性肿瘤相关的病变。确定了两组：通过手术切除的乳头状瘤（组 1）和未手术切除的乳头状瘤（组 2）。审查图表以用于癌症或高风险病变的后续诊断。使用适当的统计检验来分析数据。总共鉴定出 193 个乳头状瘤。 82 个病灶被切除（42%）。白种人女性更有可能接受切除（p = 0.03）。百分之十二的切除病变升级为恶性肿瘤。年龄增长是升级的预测因素，但这并不重要。临床表现、病变位置、活检技术和乳腺癌病史与病理升级无关。第 2 组中的两个病变最终因增大而需要切除，并且均升级为恶性肿瘤。 CNB 诊断的乳头状瘤中有 24% 在切除后病理学升级——一半升级为恶性肿瘤。所有诊断出的癌症均为 0 期或 I 期。对于未进行切除的患者，111 个乳头状瘤中有 2 个后来被切除并升级为恶性肿瘤。
Breast papillomas often are diagnosed with core needle biopsy (CNB). Most studies support excision for atypical papillomas, because as many as one half will be upgraded to malignancy on final pathology. The literature is less clear on the management of papillomas without atypia on CNB. Our goal was to determine factors associated with pathology upgrade on excision.Our pathology database was searched for breast papillomas diagnosed by CNB during the past 10 years. We identified 277 charts and excluded lesions associated with atypia or malignancy on CNB. Two groups were identified: papillomas that were surgically excised (group 1) and those that were not (group 2). Charts were reviewed for the subsequent diagnosis of cancer or high-risk lesions. Appropriate statistical tests were used to analyze the data.A total of 193 papillomas were identified. Eighty-two lesions were excised (42%). Caucasian women were more likely to undergo excision (p = 0.03). Twelve percent of excised lesions were upgraded to malignancy. Increasing age was a predictor of upgrading, but this was not significant. Clinical presentation, lesion location, biopsy technique, and breast cancer history were not associated with pathology upgrade. Two lesions in group 2 ultimately required excision due to enlargement, and both were upgraded to malignancy.Twenty-four percent of papillomas diagnosed on CNB have upgraded pathology on excision-half to malignancy. All of the cancers diagnosed were stage 0 or I. For patients in whom excision was not performed, 2 of 111 papillomas were later excised and upgraded to malignancy.