乳房切片後的放射狀結疤應予以手術切除


  【24drs.com】March 26, 2010 — 根據發表於4月份美國放射學期刊(American Journal of Roentgenology)的回溯病歷回顧結果,乳房切片後的放射狀結疤(Radial scars)應予手術切除,以排除惡性腫瘤。
  
  第一作者、義大利Udine大學的Anna Linda醫師在新聞稿中表示,放射狀結疤是屬於良性的複雜乳房病灶,不過,其中多達40%與潛在的惡性腫瘤有關。
  
  研究目標在於評估以影像導引經皮刺針切片診斷時,沒有異常增生的放射狀結疤案例的手術結果,檢視乳房攝影和超音波特徵是否可以預測哪些病灶會惡化成惡性腫瘤,而予以手術切除。
  
  研究者回顧了4458名影像導引切片患者的紀錄,發現其中62個有風險最高的放射狀結疤病灶案例,且有立體定位導引切片或超音波導引切片紀錄以及手術結果,回顧這些案例的乳房攝影、超音波、手術結果,計算經皮切片的惡性腫瘤低估率,使用費雪正確機率考驗比較有無惡性腫瘤之放射狀結疤的乳房攝影和超音波檢查結果。
  
  整體案例的經皮切片惡性腫瘤低估率為8%(5/62),超音波導引14號針切片的惡性腫瘤低估率為9% (4/43),立體定位導引11號針真空輔助切片的惡性腫瘤低估率為5% (1/19)(P = 1.000),有或沒有惡性腫瘤的放射狀結疤在乳房攝影和超音波特徵中並無顯著差異。
  
  研究限制包括,屬於回溯設計、樣本少、切片技術的異質性,此外,並未由病理科醫師回溯評估核心樣本的病理切片,僅接受原本的病理判讀。
  
  Linda醫師表示,根據經皮切片後的放射狀結疤診斷並未能排除後續手術切除時相關的惡性腫瘤;診斷為放射狀結疤之病灶的乳房攝影和超音波特徵,未能用來預測哪些病灶與惡性腫瘤有關,以進行後續手術切除,我們的結果認為,對於經皮切片後的放射狀結疤,不論其乳房攝影和超音波特徵為何,都必須進行手術切除。
  
  並未宣告外部資金或相關財務關係。

Radial Scars After Breast Biopsy Should Prompt Surgical Excision

By Laurie Barclay, MD
Medscape Medical News

March 26, 2010 — Radial scars after breast biopsy should prompt surgical excision to exclude malignancy, according to the results of a retrospective record review reported in the April issue of the AJR. American Journal of Roentgenology.

"Radial scars are complex breast lesions that are classified as benign," said lead author Anna Linda, MD, from University of Udine in Udine, Italy, in a news release. "However, up to 40 percent of them are associated with an underlying malignancy."

The objectives of the study were to assess the surgical outcome of cases of radial scar without atypia diagnosed at imaging-guided percutaneous needle biopsy and to examine whether mammographic and sonographic features can predict which lesions would be upgraded to malignancy when surgically excised.

The investigators reviewed records of 4458 consecutive imaging-guided biopsies and identified 62 cases in which radial scar was the highest-risk lesion at stereotactically guided or sonographically guided biopsy, and for which surgical excision results were available. For these cases, mammography, sonography, and surgical findings were reviewed, and the underestimation rate of malignancy of percutaneous biopsy was calculated. The Fisher's exact test allowed comparison of mammographic and sonographic findings between radial scars with vs without associated malignancy.

Percutaneous biopsy underestimated malignancy in 8% of cases overall (5/62). Underestimation rate of malignancy was 9% (4/43) for sonographically guided 14-gauge biopsies and 5% (1/19) for stereotactically guided 11-gauge vacuum-assisted biopsies (P = 1.000). Radial scars with and those without associated malignancy did not differ significantly in mammographic and sonographic features.

Limitations of this study include retrospective design, small sample size, and heterogeneous biopsy technique. In addition, the pathologic slides of core specimens were not retrospectively reviewed by a pathologist, and the original pathologic interpretation was accepted.

"A diagnosis of a radial scar based on percutaneous biopsy results does not exclude an associated malignancy at subsequent surgical excision; and mammographic and sonographic appearances of a lesion diagnosed as a radial scar are not able to predict which lesions will have associated malignancy at subsequent surgical excision," Dr. Linda said. "Our results suggest that surgical excision is required for lesions yielding radial scars at percutaneous biopsy regardless of their mammographic and sonographic appearance."

No external funding or relevant financial relationships were disclosed.

AJR. Am J Roentgenol. 2010;194:1146-1151.

    
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