空芯针活检为乳腺导管内乳头状瘤的病理低估研究  

Investigation of underestimated malignancy in patients with intraductal papillary tumors by core needle biopsy

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

机构地区：[1]上海交通大学附属瑞金医院乳腺疾病诊治中心,200025

出　　处：《中华内分泌外科杂志》2016年第2期129-134,共6页Chinese Journal of Endocrine Surgery

基　　金：国家自然科学基金（81202087）;国家自然科学基金（81172520）;国家自然科学基金（81202088）;上海市科学技术委员会基金（12ZR1446400）;上海市科学技术委员会基金（12140901503）;宁波市自然基金项目（2013A610223）

摘　　要：目的计算空芯针穿刺活检诊断为导管内乳头状瘤患者的病理低估率。分析患者临床及影像学信息，探讨低估的预测因素。方法回顾性分析2010年1月至2013年2月上海交通大学医学院附属瑞金医院乳腺疾病诊治中心的1359例接受乳腺空芯针活检（eoreneedlebiopsy，CNB）的患者，定义CNB为导管内乳头状瘤但切除病理活检为恶性的情况为病理低估。以x^2检验、Fisher精确检验和二分类logistie回归分析预测病理低估的因素。结果本研究共50例CNB诊断为导管内乳头状瘤的患者，其总低估率为44％（22，50）。CNB诊断为不典型乳头状瘤（OR=15．164，95％CI=I．349～170．443）和乳腺MRI检查BI—RADS5类（OR=26．766，95％CI=2．409～297．440）为发生低估的预测因素。结论CNB诊断为导管内乳头状瘤的患者病理低估率较高，应考虑对这部分患者均予以常规手术切除活检。特别是对CNB诊断为不典型乳头状瘤或乳腺MRI检查BI—RADS5类的患者，更应予以重视。乳腺MRI对乳腺空芯针活检的病理低估有一定预测作用。Objectives To calculate the rate of pathological underestimation for core needle biopsy （CNB）diagnosed intraductal papillary tumors, to analyze the clinical and imaging data of patients and to dis- cuss factors for underestimation. Methods A retrospective analysis of patients undergoing core needle biopsy and subsequent surgical excision was performed. 1359 female patients undergoing CNB from Jan. 2010 to Feb. 2013 in Comprehensive Breast Health Center of Ruijin hospital were analyzed. Clinical, radiological and histological variables were assessed using the Chi-square test, Fisher＇s exact test and a binary logistic regression model in order to predict pathological underestimation for tumors. Results There were 50 patients with CNB-diagnosed intraductal papillary tumors. The overall underestimation rate was about 44%（22/50）. CNB-diagnosed atypical papillary lesions （0R=15.164, 95% CI 1.49-170.443） and BI-RADS 5 by MRI （OR=26.766, 95% CI 2.409-297.440）were significantly related to underestimation in these patients. Conclusions Considering the high underestimation rate in CNB-diagnosed intraductal papillary tumors, routine surgical excision should be performed to avoid potential malignancy, especially for patients with high risk factors. MRI is helpful in these patients to predict underestimation.

关 键 词：空芯针活检 导管内乳头状瘤 乳腺癌 病理低估 预测因素 

分 类 号：R737.9[医药卫生—肿瘤]