Intraductal papillomas on core biopsy can be upgraded to malignancy on subsequent excisional biopsy regardless of the presence of atypical features
Intraductal papillomas on core biopsy can be upgraded to malignancy on subsequent excisional biopsy regardless of the presence of atypical features
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DOI：
10.1111/pin.12285
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发表时间：
2015-06-01
影响因子：
2.2
通讯作者：
Kinoshita, Takayuki
中科院分区：
文献类型：
--
作者：
Shiino, Sho;Tsuda, Hitoshi;Kinoshita, Takayuki
乳腺导管内乳头状病变是一种异质性疾病，包括良性导管内乳头状瘤（IDP）伴或不伴乳头状瘤和恶性乳头状癌。区分这些诊断可能具有挑战性。我们重新评估了诊断为IDP的芯活检标本和相应的手术切除标本，并评估了基于切除的诊断修改为恶性肿瘤的潜在风险。通过对东京国立癌症中心医院的病理学数据库进行分类，我们确定了1997年至2013年期间组织学诊断为IDP的146例核心活检病例。重新评估的诊断为79例（54%）患者的IDP不伴尿道狭窄，66例（45%）患者的IDP伴尿道狭窄，1例（1%）患者的导管原位癌（DCIS）。在34例（23%）在穿刺活检后接受手术切除的患者中，14例（41%）的组织学诊断升级为癌，不包括小叶原位癌（LCIS），包括12例无乳腺癌的IDP中的4例（33%）和22例有乳腺癌的IDP中的10例（45%）。对于所有在芯活检中诊断的IDP，不仅是有乳头状瘤的IDP，而且是没有乳头状瘤的IDP，都应该考虑完全手术切除，特别是当临床或影像学诊断结果不能排除恶性肿瘤的可能性时，因为乳头状病变包括各种形态学表现。
Intraductal papillary lesions of the breast constitute a heterogeneous entity, including benign intraductal papilloma (IDP) with or without atypia and malignant papillary carcinoma. Differentiating between these diagnoses can be challenging. We re-evaluated core biopsy specimens that were diagnosed as IDP and the corresponding surgical excision specimens, and assessed the potential risk for the diagnosis to be modified to malignancy based on excision. By sorting the pathology database of the National Cancer Center Hospital, Tokyo, we identified 146 core biopsy cases that were histologically diagnosed as IDP between 1997 and 2013. The re-evaluated diagnosis was IDP without atypia in 79 (54%) patients, IDP with atypia in 66 (45%), and ductal carcinoma in situ (DCIS) in 1 (1%). Among the 34 patients (23%) who underwent surgical excision subsequent to core biopsy, histological diagnosis was upgraded to carcinoma, excluding lobular carcinoma in situ (LCIS), in 14 (41%) cases, including 4 (33%) of 12 IDPs without atypia and 10 (45%) of 22 IDPs with atypia. Complete surgical excision should be kept in mind for all IDPs diagnosed on core biopsy, not only IDPs with atypia but IDPs without atypia, especially when clinical or imaging diagnosis findings cannot rule out the possibility of malignancy, because papillary lesions comprise a variety of morphological appearances.