乳腺空芯针活检为不典型导管上皮增生的病理低估研究  

Investigation of downgrading of atypical ductal hyperplasia of breast on core needle biopsy

作　　者：孙龙[1,2] 陈小松[1] 吴佳毅[1] 黄欧[1] 梁跃[1] 朱丽[1] 何建蓉[1] 李亚芬[1] 陈伟国[1] 沈坤炜[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院外科乳腺疾病诊治中心,上海200025 [2]宁波市第二医院乳腺外科,浙江宁波315000

出　　处：《外科理论与实践》2015年第1期48-52,共5页Journal of Surgery Concepts & Practice

摘　　要：目的：计算乳腺空芯针穿刺活检（core needle biopsy,CNB）诊断为不典型导管上皮增生（atypical ductal hyperplasia,ADH）病人的病理低估率。分析病人临床及影像学信息,探讨低估的预测因素。方法：回顾性分析2010年1月至2013年2月期间,本中心60例CNB诊断为ADH病人。定义病理低估为CNB是ADH但切除活检诊断是恶性的。以卡方检验、Fisher精确检验和二分类Logistic回归分析病理低估的预测因素。结果：本研究60例CNB诊断为ADH病人的病理低估率为65.0%（39/60）。乳腺X线检查发现恶性征象的微钙化（OR=7.988,95%CI：4.997~12.810,P=0.001）、乳腺X线检查影像报告数据系统（BI-RADS）≥4级（OR=10.875,95%CI：2.747~43.051,P〈0.001）和乳腺磁共振检查BI-RADS 5级（OR=10.000,95%CI：1.183~84.504,P=0.034）是提示病理低估的预测因素,其中乳腺X线检查发现恶性征象的微钙化（OR=5.613,95%CI：1.032~30.539,P=0.046）是提示病理低估的独立预测因素。结论：CNB诊断为ADH病人的病理低估率较高,需考虑予以手术切除活检。特别是伴有危险因素的病人,更应重视。乳腺磁共振对ADH的病理低估有一定预测作用。Objective To calculate the downgrading rate of atypical ductal hyperplasia（ADH） of breast on core nee-dle biopsy（CNB） and to identify the predictive factors with the analysis of clinical data and imaging information. Methods A retrospective analysis of 60 female patients who underwent CNB and subsequent surgical excision was performed from January 2010 to February 2013 in Comprehensive Breast Health Center of Runjin Hospital. The predictive factors of downgrading of ADH on CNB were assessed using Chi-square test, Fisher′ s exact tests and binary Logistic regression model. Results We evaluated the data of 60 patients with CNB-diagnosed ADH shown the downgrading rate 65%（39/60）.It was resulted from the analysis on predictive factors of downgrading of ADH including the microcalcification on mammog-raphy（OR=7.988, 95%CI： 4.997-12.810, P=0.001）, BI-RADS ≥4 at mammography（OR=10.875, 95%CI： 2.747-43.051,P0.001） and BI-RADS 5 at breast MRI（OR=10.000, 95%CI： 1.183-84.504, P=0.034）. The microcalcification on mammography was suggested as an independent factor of predicting downgrading of ADH（ OR=5.613, 95%CI： 1.032-30.539,P=0.046） from the analysis using binary Logistic regression. Conclusions Considering the high downgrading rate of ADH on CNB for the patients with breast lesions, surgical biopsy should be performed especially for those patients with high risk factors. Breast MRI is helpful to predict potential malignancy for the patients with downgrading of ADH.

关 键 词：空芯针活检 不典型导管上皮增生 乳腺癌 病理低估 预测因素 

分 类 号：R737.9[医药卫生—肿瘤]