Predictive Factors for Upgrading Patients with Benign Breast Papillary Lesions Using a Core Needle Biopsy.
Predictive Factors for Upgrading Patients with Benign Breast Papillary Lesions Using a Core Needle Biopsy.
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DOI：
10.4048/jbc.2016.19.4.410
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发表时间：
2016-12
影响因子：
2.4
通讯作者：
Chae BJ
中科院分区：
文献类型：
--
作者：
Hong YR;Song BJ;Jung SS;Kang BJ;Kim SH;Chae BJ
摘要导管内乳头状瘤是一种良性且具恶性潜能的乳房疾病，通常建议完全手术切除。本研究的目的是探讨良性乳头状病变（BPL）患者升级的预测因素。本研究是一项使用前瞻性收集队列的观察性研究。在2009年1月至2015年5月期间，共招募了13，049名接受乳腺病变空芯针活检（CNB）的患者。我们回顾了所有经CNB病理证实的BPL患者。在总共592个病变中，对363个病变进行了手术治疗。按病理类型分，无尿崩症的病变升级率最低（无尿崩症6.0%，有尿崩症26.8%，乳头状瘤31.5%; p <0.001）。单因素分析显示，在没有乳腺癌的IDP中，诊断时的年龄、超声检查BPL的大小和乳腺X线检查的密度与乳腺癌的升级有关。多变量分析显示，年龄> 54岁和病变大小> 1 cm与恶性进展显著相关（比值比[OR]= 4.351，p = 0.005和OR = 4.236，p = 0.001）。手术治疗的适应症可定义为年龄> 54岁且肿块大小> 1 cm，即使是CNB结果中无尿道狭窄的IDP;这也包括伴有尿道狭窄或乳头状肿瘤的IDP病例。因此，我们建议，密切观察，而不手术是足够的年轻妇女与一个小的IDP没有尿道。
Intraductal papilloma (IDP) is a benign breast disease with malignant potential, for which complete surgical excision is usually recommended. The aim of the present study was to investigate predictive factors for upgrading patients with a benign papillary lesion (BPL). This study was an observational study using a prospectively collected cohort. In total, 13,049 patients who underwent a core needle biopsy (CNB) for a breast lesion between January 2009 and May 2015 were enrolled. We reviewed all patients with pathologically confirmed BPL from a CNB. Surgical treatment was performed for 363 out of a total of 592 lesions. According to the pathological differences, the lowest upgrade rate was shown in IDP without atypia (without atypia, 6.0%; with atypia, 26.8%; papillary neoplasm, 31.5%; p<0.001). The univariate analysis showed that, in IDP without atypia, the age at diagnosis, size of BPL on ultrasonography, and density on mammography were associated with upgrading. The multivariate analysis revealed that age >54 years and lesion size >1 cm were significantly associated with upgrade to malignancy (odds ratio [OR]=4.351, p=0.005 and OR=4.236, p=0.001, respectively). The indications for surgical treatment can be defined as age >54 years and mass size >1 cm, even in IDP without atypia in the CNB results; this also includes cases of IDP with atypia or papillary neoplasm. Therefore, we suggest that close observation without surgery is sufficient for younger women with a small IDP without atypia.