Underestimation of breast cancer in intraductal papillomas treated with vacuum-assisted core needle biopsy
Underestimation of breast cancer in intraductal papillomas treated with vacuum-assisted core needle biopsy
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DOI：
10.5603/gp.2019.0022
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发表时间：
2019-01-01
影响因子：
1.3
通讯作者：
Szpor, Joanna
中科院分区：
文献类型：
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作者：
Hodorowicz-Zaniewska, Diana;Siarkiewicz, Benita;Szpor, Joanna
目的：本研究的目的如下：1）确定真空辅助空芯针活检在乳腺导管内乳头状瘤诊断和治疗中的适用性; 2）确定增加低估乳腺癌风险的因素。材料和方法：2002-2017年间，一个中心共诊断出222例导管内乳头状瘤，（201例使用真空辅助空心针超声引导活检，21例使用立体定向活检）。所有患者进行了预定的后续imaging.Results：纯乳头状瘤被诊断为158名妇女，而乳头状瘤与乳腺癌，在这种情况下，不典型导管增生（ADH），被发现在29例。在后者中，3例浸润性癌和5例导管原位癌（DCIS）通过开放手术活检发现。这组患者中乳腺癌的低估率为20%。总的来说，ADH的存在使BC的风险增加了13倍，与其他伴随病变相比，ADH被证明是最重要的预测因素。此外，年龄、非根治性活检切除、BI-RADS超声和乳腺X线评分高也增加了恶性肿瘤的可能性。在对照随访期间，没有IP复发的情况下，在没有开放性手术pilots.Conclusions组观察到的原发性定位：乳腺导管内乳头状瘤的诊断和管理中，活检辅助空芯针活检是一种有效的工具。单纯性导管内乳头状瘤，且诊断与临床表现之间的数据相关性得到证实时，不需要手术切除。无论如何，如果残留病变和老年人群中，建议谨慎。开放性手术活检应继续作为标准治疗的情况下，与子宫内膜异位症和不一致的临床和病理学数据。
Objectives:The aims of the study were as follows:1) to determine the applicability of vacuum-assisted core needle biopsy in the diagnosis and management of intraductal papillomas of the breast; 2) to define factors which increase the risk for underestimation of breast cancer.Material and methods: Between 2002-2017, a total of 222 cases of intraductal papillomas were diagnosed in one center (201 using vacuum-assisted core-needle ultrasound-guided biopsy and 21 using stereotactic biopsy). All patients underwent scheduled follow-up imaging.Results: Pure papillomas were diagnosed in 158 women, whereas papillomas with atypia, in this case atypical ductal hyperplasia (ADH), were found in 29 subjects. In the latter group, 3 cases of invasive carcinoma and 5 cases of ductal carcinoma in situ (DCIS) were detected using open surgical biopsy. Breast cancer underestimation in that group of patients was 20%. Overall, ADH, whose presence increases the risk for BC by thirteen-fold as compared to other accompanying lesions, proved to be the most important predictive factor. Also, age, non-radical biopsy excision, and high BI-RADS ultrasound and mammogram scores increased the probability of malignancy. During the control follow-up, no cases of IP recurrence in the primary localization were observed in the group without open surgical biopsy.Conclusions: Vacuum-assisted core needle biopsy is an efficient tool in the diagnosis and management of intraductal papillomas of the breast. Surgical excision is not indicated in cases when a pure intraductal papilloma, and data correlation between the diagnosis and the clinical presentation were confirmed. Regardless, caution is advised if residual lesions were left and in older populations. Open surgical biopsy should remain the standard of care in cases with atypia and discordance between clinical and pathology data.