Id-1和Cyclin D1在乳腺浸润性导管癌中的表达及意义

目的：探讨Id-1、Cyclin D1在乳腺浸润性导管癌中的表达及其意义。方法：采用免疫组织化学Elivision二步法检测80例乳腺浸润性导管癌、18例导管内癌、15例单纯性导管上皮增生及15例正常乳腺组织中Id-1和Cyclin D1蛋白的表达情况，并分析其临床病理意义。结果：在乳腺浸润性导管癌中Id-1和Cyclin D1阳性表达明显高于正常乳腺组织、单纯性导管上皮增生及导管内癌（P〈0.05）；Id-1蛋白阳性表达与浸润性导管癌TNM分期及淋巴结转移呈正相关（P〈0．05）；Cyclin D1阳性表达与组织学分级正相关（P〈0．05）；Id-1与Cyclin D1阳性表达正相关（P〈0．05）。Id-1和Cyclin D1同时阳性表达与生存期相关（P〈0．05）。结论：Id-1和Cyclin D1在乳腺浸润性导管癌的发生、演变过程中起重要作用，联合检测Id-1和Cyclin D1可作为判断乳腺浸润性导管癌预后不良的指标。     

葡萄糖转运蛋白1在乳腺癌组织中的表达及其临床意义

目的：探讨乳腺癌组织中葡萄糖转运蛋白1（GLUT1）的表达与细胞核增殖抗原（Ki-67）表达的关系和临床意义，为乳腺病变的诊断、预后及治疗提供理论基础。方法：采用免疫组化方法（Envision法）检测乳腺组织（乳腺腺瘤和乳腺腺病共22例、原位癌17例、普通型乳腺浸润性癌48例、腋窝淋巴结乳腺癌转移灶21例）中GLUT-1和Ki-67的表达，并对GLUT-1与Ki-67表达的关系进行相关性分析。结果：GLUT-1阳性产物定位于上皮细胞胞膜和细胞浆，在正常乳腺、乳腺良性病变组织中无阳性表达或散在少数轻微着色，而在乳腺癌组织中有明确阳性表达，GLUT-1的表达随组织分级增强（P〈0．01）；乳腺癌组织中GLUT-1的阳性表达率与淋巴结转移、临床病理TNM分期呈明显正相关（P〈O．05），而与病理组织分型无明显相关（P〉O．05）。乳腺癌组织中，Ki-67标记指数范围为6．2％～68％，GLUT-1染色强阳性的病例其Ki67标记指数高于GLUT-1染色阳性及中等阳性的病例（P〈0．05）。结论：GLUT-1在乳腺癌的表达与乳腺上皮的恶变密切相关，GLUT-1阳性表达提示肿瘤预后不良及较强的浸润生物学行为，靶向GLUT-1可对乳腺肿瘤进行有价值的检测和针对性治疗。     

乳腺浸润性导管癌组织AIB1与Ki67表达及相关性研究

目的：探讨乳腺癌扩增性抗原1（AIB1）及增殖细胞核抗原（Ki67）蛋白在乳腺浸润性导管癌（IDC）中的表达及二者相关性。方法采用免疫组织化学SP法检测100例乳腺IDC组织石蜡标本中AIB1及Ki67蛋白的表达情况。结果 AIB1及Ki67蛋白阳性表达率分别为75．00％和80．00％。它们的表达均与腋窝淋巴结转移、病理组织学分级、临床分期关系密切（P＜0．05）,而均与患者年龄无关（P＞0．05）;AIB1表达与肿瘤大小无关（P＞0．05）,而Ki67表达与肿瘤大小有关（P＜0．05）;多因素Logistic回归分析显示,组织学分级是影响AIB1及Ki67阳性表达最主要因素,P值均＜0．05;在80例Ki67蛋白阳性表达的乳腺IDC中有68例同时表达AIB1,AIB1与Ki67的表达呈正相关（P＜0．05）。结论 AIB1及Ki67蛋白可能是乳腺IDC患者的不良预后因素;二者可能共同促进乳腺癌细胞增殖、侵袭及转移,联合检测可能有助于更准确地判断乳腺IDC的预后。     

乳腺癌线样或线样分支状钙化与病理类型和分子表达的关系

目的：探讨乳腺癌线样或线样分支状钙化与组织病理学及分子表达之间的关系及临床意义,评价微钙化预测乳腺癌组织病理类型及分子亚型的可行性。方法：回顾性分析150例钙化型乳腺癌（非肿块）患者的病例资料,由两位高年资医师根据钙化形态（线样钙化或非线样钙化）进行分组,分析钙化形态与乳腺癌病理类型（乳腺导管原位癌、浸润性导管癌）及分子表达[雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子相关基因（HER2）]的关系。结果：乳腺导管原位癌（DCIS）中线样或线样分支状钙化组中伴局部微浸润的比例明显高于非线样或线样分支钙化组（27／37VS9／22,P〈0．05）;线样或线样分支状钙化组中雌激素受体（ER）的表达率低于非线样或线样分支状钙化（8／22VS22／34,P〈0．05）,而HER2的过表达率高于非线样或线样分支状钙化组（17／39VS12／17,P〈O．05）。结论：线样或线样分支状钙化与乳腺癌病理类型和分子表达具有一定的相关关系,可以为乳腺癌治疗策略的制定和预后预测的提供参考。     

DWI及DCE-MRI对乳腺纯导管原位癌、导管原位癌伴微浸润及浸润导管癌的鉴别诊断价值

【摘要】目的：探讨扩散加权成像（DWI）及动态增强磁共振成像（DCE-MRI）特征对乳腺导管原位癌（DCIS）、导管原位癌伴微浸润（DCIS-Mi）和浸润性导管癌（IDC）的鉴别诊断价值。方法：39例DCIS、43例DCIS-Mi和42例IDC患者,术前均行乳腺DCE-MRI和DWI检查。比较3组DWI和MRI-DCE特点。结果：纯DCIS、 DCIS-Mi及IDC的最小ADC值（ADCMin）的中位数分别为1.35（1.33,1.36）、1.25（1.23,1.26）和1.08（1.06,1.12）×10-3mm2/s,呈降低趋势且组间差异有统计学意义（P＜0.05）;最大与最小ADC值的差值（ADCDR）的中位数分别为0.13（0.11,0.14）、0.21（0.19,0.24）和0.34（0.31,0.37）×10-3mm2/s,呈增高趋势且组间差异有统计学意义（P＜0.05）。ADCMin值取1.285×10-3mm2/s是鉴别纯DCIS和DCIS-Mi最佳阈值,取1.175×10-3mm2/s是鉴别DCIS-Mi和IDC最佳阈值;ADCDR值取0.165×10-3mm2/s鉴别纯DCIS和DCIS-Mi最佳阈值,取值0.265×10-3mm2/s是鉴别纯DCIS-Mi和IDC最佳阈值。DCIS-Mi主要表现为非肿块强化,倾向于节段分布,内部强化特点为不均匀或簇环状强化,少数肿块样DCIS-Mi常边缘呈毛刺状或不规则,内部强化特点为不均匀或边缘强化;非肿块样纯DCIS趋向于线样分布,内部强化特点一般较均匀,肿块样DCIS往往边缘清晰,内部强化特点均匀或不均匀;IDC多表现为肿块样强化,其边缘和内部强化特点常表现多种形成。结论：DCE-MRI联合DWI有助于鉴别乳腺纯DCIS、DCIS-Mi和IDC,尤其ADCMin、ADCDR、簇环状强化和边缘强化强化对诊断DCIS-Mi有一定帮助。     

女性激素相关生物指标在乳腺癌癌前病变中的表达与乳腺癌发生的关系

目的：探讨女性激素相关生物指标雌激素受体（estrogen receptor，ER）、孕激素受体（progesterone receptor，PR）、雌激素诱导基因（estrogen induced gene，pS2）在乳腺非典型增生癌变过程中的意义。方法：检测正常乳腺、乳腺单纯性增生、乳腺非典型增生及原发性乳腺癌细胞中ER、PR、pS2的表达。结果：ER、PR、pS2在26例正常对照组中阳性表达率分别为11．53％，15．38％，0；在50例乳腺单纯性增生疾病中阳性率分别为22％，28％，8％；在45例非典型增生症中阳性率分别为64．44％，73．33％，31．11％；在46例原发乳腺癌中阳性率分别为67．39％，56．52％，34．78％。结论：女性激素相关生物指标ER、PR在不典型增生细胞中检测阳性时临床上应特别重视，其发生乳腺癌的可能性增大。pS2的阳性表达可能与乳腺癌的发生也有一定的关系。     

乳腺非典型增生和普通型增生的X线征象分析

目的:通过分析乳腺非典型增生和普通型增生的X线征象,探讨X线检查在两者鉴别中的诊断价值。方法 :回顾性分析688例患者,其中普通型乳腺增生367例,乳腺非典型增生321例,分析2组X线征象差异。结果:2组平均年龄比较,差异无统计学意义(P 0.05),但2组年龄分段构成差异有统计学意义(P0.05),非典型增生≥65岁所占比例(11.2%)较普通型增生比例(5.0%)高。2组肿块形态、边缘、密度比较差异均有统计学意义(均P0.05)。2组钙化形态、分布及不对称类型和结构紊乱差异均有统计学意义(均P0.05)。普通型增生中以球形不对称为主要表现,非典型增生以局灶性不对称为主要表现。结论:X线征象对乳腺非典型增生和普通型增生有重要的鉴别诊断价值。     

西宁地区VEGF和HER-2在乳腺疾病血管生成中的意义

目的：研究西宁地区（海拔2261m）乳腺癌组织中原癌基因HER-2和VEGF的表达与肿瘤的发生、发展相关性。方法：应用免疫组织化学方法检测西宁地区42例乳腺癌组织及28例乳腺良性增生组织中HER-2和血管内皮生长因子（VEGF）的表达。结果：在西宁地区乳腺癌组VEGF高表达比例和HER-2表达均较乳腺良性疾病组高，差别有统计学意义（P〈0．05）；乳腺癌组VEGF表达与肿块大小、淋巴结是否转移和临床分期有关，与年龄、ER、PR无关，HER-2与淋巴结是否转移有关，与其他因素均无关；HER-2和VEGF表达明显相关（P〈0．05）。结论：西宁地区HER-2和VEGF表达与平原地区相似在乳腺癌发生、发展及血管生成密切相关；而高海拔缺氧对其无明显的影响。     

CyclinD1、P27、CK19、ALDH1A1在乳腺病变中表达及意义

目的探讨细胞周期D1(Cyclin D1)、P27、细胞角蛋白19(CK19)、ALDH1A1在乳腺病变中的表达及其临床意义。方法采用免疫组化法检测79例乳腺组织标本(包括正常乳腺、乳腺增生、乳腺导管原位癌、乳腺浸润性导管癌)中Cyclin D1、P27、CK19、ALDH1A1的表达情况,分析其与乳腺癌干细胞增殖及乳腺病变组织分化程度之间的关系。结果正常乳腺、乳腺增生、乳腺导管原位癌、乳腺浸润性导管癌中Cyclin D1、ALDH1A1的表达逐渐上升,P27、CK19的表达逐渐下降;乳腺正常及良性增生组织中Cyclin D1、CK19、ALDH1A1的表达明显低于乳腺导管原位癌及浸润性导管癌(P<0.05);乳腺正常及良性增生组织中P27的表达明显高于导管原位癌及浸润性导管癌(P<0.05)。结论 Cyclin D1、P27相互作用调节乳腺癌干细胞的发生及发展过程,CK19、ALDH1A1可作为乳腺癌诊断及恶性程度评估的参考指标。     

乳腺高危病变的乳腺X线诊断及技术进展

乳腺高危病变包括良性病变及原位癌,具有发生乳腺癌的风险。高危病变首诊主要依赖于穿刺活检,但首诊后存在一定的病变升级率。对于不同的高危病变,如不典型导管增生（ADH）、乳头状瘤伴不典型增生、放射状瘢痕、小叶原位癌（LCIS）、不典型小叶增生（ALH）、黏液囊肿样病变、平坦上皮非典型增生等,乳腺X线检查的诊断及处理原则并不完全相同。就乳腺X线检查对高危病变的诊断、处理、预后评估的研究进展予以综述。     

溢液性乳腺癌的乳腺导管造影表现及病理基础

目的:分析溢液性乳腺癌的乳腺导管造影表现及其病理基础,为临床提供可靠的诊断依据,以提高早期乳腺癌的诊治水平。方法:临床表现为乳头溢液并经手术、病理证实的乳腺癌患者26例,回顾性观察其乳腺导管造影表现,并与病理结果对比分析。结果:26例中,导管原位癌8例;浸润性导管癌5例;导管原位癌伴早期浸润7例;复合型癌3例,其中导管原位癌合并浸润性小叶癌2例,浸润性导管癌合并浸润性小叶癌1例;导管内乳头状瘤病癌变3例,其中乳腺X线平片未发现异常5例,毛刺或分叶状肿块2例,肿块伴钙化9例,多形性钙化灶10例。乳腺导管造影主要表现:导管内充盈缺损伴有不同程度导管扩张;导管管壁浸润破坏对比剂渗漏,形成"潭湖征";导管管壁不规则,呈"虫蚀样"改变或"断续征"。本组乳腺导管造影诊断乳腺癌的符合率为88.4%。结论:乳腺导管造影是溢液性乳腺癌诊断的安全而有效的检查方法,具有很高的定性、定位诊断价值,尤其对临床触诊阴性的早期乳腺癌能作出较准确的诊断,提高了早期乳腺癌的检出率。     

Stereotactic vacuum-assisted breast biopsy in 268 nonpalpable lesions

PURPOSE: We evaluated the reliability of stereotactic vacuum-assisted breast biopsies (VAB) from our personal experience. MATERIALS AND METHODS: Between January 2003 and December 2005, 268 patients underwent VAB with an 11-gauge probe at our institution. Inclusion criteria were nonpalpable lesions, undetectable by ultrasound and suspected at mammography (microcalcifications, circumscribed mass, architectural distortion), for which cytology and/or core biopsy could not provide a definite diagnosis. Lesion mammographic patterns were microcalcifications in 186 cases (77.5%), mostly localised clusters (130/186: 70%); circumscribed mass with or without microcalcifications in 36 cases (15%) and architectural distortion with or without microcalcifications in 18 cases (7.5%). On the basis of the Breast Imaging Reporting and Data System (BI-RADS) classification, 16 cases (7%) were graded as highly suspicious for malignancy (BI-RADS 5), 81 (34%) as suspicious for malignancy (BI-RADS 4b), 97 (40%) as indeterminate (BI-RADS 4a) and 46 (19%) as probably benign (BI-RADS 3). Lesion size was 20 mm in only 38 cases (16%), 30 of which appeared as microcalcifications. RESULTS: In 28/268 lesions (10.5%) the biopsy could not be performed (nonidentification of the lesion; inaccessibility due to location or breast size). In 12/240 (5%) biopsies, the sample was not representative. Pathology revealed 100/240 (42%) malignant or borderline lesions and 140/240 (58%) benign lesions. Among the malignant lesions, 16/100 (16%) were invasive carcinoma [infiltrating ductal carcinoma (IDC) or infiltrating lobular carcinoma (ILC)], 13/100 (13%) were microinvasive (T1mic), 35/100 (35%) were ductal carcinoma in situ (DCIS), 9/100 (9%) were lobular carcinoma in situ (CLIS). Among the borderline lesions, 27/100 (27%) were atypical epithelial hyperplasia [atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH)]. In 9/100 surgically treated lesions (9%), there was discordance between the microhistological findings of VAB and the pathological results of the surgical procedure: 8/9 were underestimated by VAB (four ADH vs. DCIS, three DCIS vs. IDC, one ADH vs. IDC), and 1/9 was overestimated (T1mic vs. DCIS). Complications following VAB occurred in 9/240 patients (3.7%). CONCLUSIONS: In our experience, VAB showed fair reliability in the diagnosis of nonpalpable breast lesions despite a portion of failed (10.5%), nonsignificant (5%) procedures and underestimated lesions (9%).     

自动乳腺全容积扫查系统结合乳腺影像报告和数据系统对乳腺导管内癌的诊断研究

目的分析乳腺导管内癌的自动乳腺全容积扫查系统(ABVS)的超声图像特征及利用乳腺影像报告数据系统-超声版(BI-RADS-US)进行最终评估,探讨超声对该病的诊断价值。方法回顾性分析并总结2010年9月～2011年10月间我院经手术病理证实的28例乳腺导管内癌的ABVS声像图特征,并依照BI-RADS-US进行最终评估。结果据乳腺导管内癌的ABVS声像图特征,可分为5大类:①导管扩张填充型;②团块型;③无占位的单纯钙化点型;④结构紊乱型;⑤囊实性混合回声型。利用BI-RADS-US评估乳腺导管内癌,得到诊断符合率为96.4%。结论自动乳腺全容积扫查系统结合乳腺影像报告和数据系统在乳腺导管内癌的诊断过程中发挥着重要作用。     

彩色多普勒超声对乳腺髓样癌的鉴别诊断价值

目的 探讨乳腺髓样癌的超声表现及临床特征.方法 回顾性分析1 997年～2012年经手术病理证实的乳腺髓样癌12例,术前进行超声检查,术后病理诊断、免疫组化检测,并随机选择同期浸润性导管癌120例进行对比分析.结果 髓样癌超声表现形态规则9例（75％）,浸润性导管癌形态规则46例（38.33％）,x2=6.0343,P=0.014;髓样癌超声表现后方效应增强9例（75％）,浸润性导管癌后方效应增强31例（25.83％）,x2=12.4862,P=0.0004;髓样癌超声表现血流信号丰富5例（55.6％）,浸润性导管癌血流信号丰富51例（42.5％）,x2=0.5809,P=0.446;髓样癌超声表现腋下淋巴结肿大2例（1 6.7％）,浸润性性导管癌腋下淋巴结肿大56例（46.7％）,x2=3.9858,P=0.0459;髓样癌cerb B2表达阳性者3例（25％）,浸润性性导管癌阳性者67例（55.8％）,x2=4.1638,P=0.0413;髓样癌、浸润性性导管癌腋下淋巴结肿大与c-erbB-2表达均存在相关性（P＜0.05）.结论乳腺髓样癌超声特征表现为：体积较大,形态规则,后方效应增强,肿瘤内部血流信号丰富,腋下淋巴结肿大较少,c-erbB-2阴性表达.     

乳腺癌超声分型与病理组织学分型的对照研究

目的:探讨乳腺癌超声分型与病理组织学分型之间的关系及临床意义。方法:对119例术后证实为乳腺癌患者术前的彩色多普勒超声声像图进行分型,并与病理分型对照,分析各型乳腺癌的超声图像特点及其与病理组织学诊断的符合率。结果:119例乳腺癌患者超声发现病灶126个,根据声像图表现分为5型:Ⅰ型(结节型)10例,病理为非浸润性癌1例,早期浸润性癌1例,混合性癌1例,浸润性癌7例,本型超声与病理诊断符合8例(80%)。Ⅱ型(团块型):ⅡA型(边界清晰型)3例,病理为髓样癌3例;ⅡB型(边缘毛糙型)104例,病理为非浸润性癌4例,早期浸润癌6例,浸润性非特殊类型癌93例,罕见型癌1例。超声与病理诊断符合率为98.1%(105/107)。Ⅰ型与Ⅱ型超声与病理诊断符合率比较差异有统计学意义(χ2=167.744,P0.01);Ⅲ型(囊实型)3例,病理为囊内乳头状癌2例,浸润性癌1例。超声与病理诊断符合2例。Ⅳ型(导管型)4例,病理为导管内原位癌1例,早期浸润癌1例,浸润性癌2例。超声与病理诊断符合2例。Ⅴ型(弥漫型)2例,病理诊断早期浸润性癌1例,浸润性导管癌1例。超声与病理诊断符合1例。结论:乳腺癌超声分型与病理分型密切相关,肿块的超声形态特点对组织学分类有提示作用。     

乳腺癌钼靶X线与超声诊断的对比研究

目的 比较钼靶X线与超声对乳腺癌的诊断价值.方法 经手术及病理证实同时行钼靶X线与超声检查的乳腺癌病例40例.钼靶X线采用常规摄片方法摄片;超声探头频率10 MHz,分别在2种影像下对乳腺癌进行分析、诊断,比较二者诊断结果的差异.结果 40例乳腺癌患者中,包括浸润性导管癌29例,导管内癌5例,小叶癌4例,黏液腺癌1例,炎性乳癌1例,X线诊断正确34例,超声诊断正确29例(x2=13.83,P＜0.05).结论 对乳腺癌的检出,钼靶X线较超声有优势.     

Stereotactic and sonographic large-core biopsy of nonpalpable breast lesions: results of the Radiologic Diagnostic Oncology Group V study

RATIONALE AND OBJECTIVES: To determine the diagnostic accuracy of stereotactically and sonographically guided core biopsy (CB) for the diagnosis of nonpalpable breast lesions. MATERIALS AND METHODS: Twenty-two institutions enrolled 2,403 women who underwent imaging-guided fine needle aspiration followed by imaging-guided large-CB of nonpalpable breast abnormalities. All mammograms were reviewed for study eligibility by one of two breast imaging radiologists. The protocol for image-guided biopsy, using either ultrasound (USCB) or stereotactic (SCB) guidance, was standardized at all institutions and all biopsy specimens were over-read by one of three expert pathologists. Patients with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, or lobular neoplasia on CB underwent surgical excision. Those with negative CB but suspicious ("discordant") pre-biopsy mammography also underwent surgical excision. Patients having a negative CB that was concordant with the pre-biopsy mammography suspicion were assigned to follow-up mammography at 6, 12, and 24 months following CB. RESULTS: A gold standard diagnosis based on definitive histopathologic diagnosis, mammography follow-up, or an imputed gold standard diagnosis was established for 1,681 patients. Of 310 cases with a gold standard diagnosis of invasive breast carcinoma, 261 (84.2%) were invasive carcinoma, 31 (10%) were ductal carcinoma in situ (DCIS), four (1.3%) were ADH, one (0.3%) was a non-breast cancer, and 13 (4.2%) were benign on CB. For 138 cases with a gold standard diagnosis of DCIS, 113 (81.9%) were DCIS, 20 (14.5%) were ADH, and five (3.6%) were benign on CB. For 57 cases (13 masses, 44 calcifications) with an initial CB diagnosis of ADH, atypical lobular hyperplasia or lobular neoplasia, 20 (35.1%) had a gold standard diagnosis of DCIS (4 masses, 16 calcifications) and four (7.0%) had a gold standard diagnosis of invasive cancer (4 calcifications). Of 144 cases (22 masses, 122 calcifications) with an initial CB diagnosis of DCIS, 31 (21.5%) had a gold standard diagnosis of invasive cancer (10 masses, 21 calcifications). The sensitivity, specificity and accuracy for CB by either imaging guidance method in this trial were .91, 1.00, and .98, respectively. The sensitivity, predictive value negative, and accuracy of CB for diagnosing masses (.96, .99, and .99, respectively) were significantly greater (P < .001) than for calcifications (.84, .94, and .96, respectively). The sensitivity (.89) of SCB for diagnosing all lesions was significantly lower (P = 0.029) than that of USCB (.97) because of the preponderance of calcifications biopsied by SCB versus USCB. There was no difference between USCB and SCB in sensitivity, predictive value negative, or accuracy for the diagnosis of masses (97.3, 98.9, and 99.2, respectively for USCB; 95.6, 98.5, and 98.9 respectively for SCB). CONCLUSION: Percutaneous, imaged-guided core breast biopsy is an accurate diagnostic alternative to surgical biopsy in women with mammographically detected suspicious breast lesions.     

乳腺导管造影在溢液性乳腺癌诊断中的应用

目的：探讨不同病理类型的溢液性乳腺癌在乳腺导管造影中的X线征象,提高对本病的诊断水平。方法：搜集经手术病理证实并行乳腺X线片及腺导管造影检查的乳腺癌108例,溢液性质为血性62例,浆液46例,临床因溢液而疑及乳腺癌。分析不同病理类型乳腺癌（浸润性导管癌64例,浸润性小叶癌23例,其他21例包括髓样癌7例,化生性癌1例,富于脂质癌2例,导管原位癌7例,粘液癌1例,浸润性乳头状癌3例）在乳腺导管造影中的X线征象。结果：乳腺癌导管造影主要征象：鼠尾征13例,导管走行僵直16例,充盈缺损（杯口征）7例,导管扩张99例,截断征（刀切征）24例,导管结构紊乱60例,断续征37例,虫蚀样改变30例,潭湖征32例。108例乳腺癌中有106例合并两种以上征象。浸润性导管癌最多见,64例,占50%;其次为浸润性小叶癌,23例,占21.3%。结论：充分认识溢液性乳腺癌的乳腺导管造影征象,对进一步明确乳腺癌的诊断具有重要价值,合并征象越多,对乳腺癌的诊断价值越高。     

Accuracy of percutaneous core biopsy of isolated breast microcalcifications identified by mammography. Experience with a vacuum-assisted large-core biopsy device

PURPOSE: To evaluate the diagnostic accuracy of 11-G vacuum-assisted stereotactic core biopsy (VAB) of isolated clusters of microcalcifications identified by mammography. MATERIALS AND METHODS: Retrospective analysis of 364 consecutive procedures from February 1999 to June 2002. Final outcome was histological diagnosis at surgery or mammographic follow-up. Linkage with local cancer registry was available. Diagnostic accuracy and upgrading of atypical ductal hyperplasia (ADH) to carcinoma or of ductal carcinoma in situ (DCIS) to invasive carcinoma (INV) was evaluated. The positive predictive value (PPV) of radiological judgement (score 1 to 5) and of the cluster volume (only for unifocal lesions) for ADH or more severe lesions was also considered. RESULTS: A total of 364 consecutive VAB procedures were evaluated (average age 54.9, range 33-81). VAB report was negative, ADH, DCIS or INV in 192, 22, 126 or 24 cases, respectively. Of 188 cases with ADH or more severe reports at VAB or surgical biopsy 16 had an originally negative VAB report, yielding a sensitivity of 91.4%. Upgrading at surgical biopsy for cases with follow-up was 29.4% (5/17) for ADH (DCIS=2, INV=3) and 17.3% (20/115) for DCIS. Of 221 cases with known outcome and mammograms available for review PPV was 37.1%, 65.9%, 90.9%, and 89.4% for radiological suspicion degrees 2,3,4 and 5, respectively (chi squared for trend = 32.44, p<10(-6)) and was 70.0%, 72.4% and 89.4% for cluster volumes of 0-60, 61-500 and >500 mmc, respectively (chi squared for trend= 2.36, p=0.12) among 195 unifocal clusters. No microcalcifications were found at core radiography in 20 cases (VAB negative=18, ADH=1, INV=1) with DCIS or INV occurring in 4 or 1 case, respectively, at further surgery. CONCLUSIONS: Core biopsy avoids unnecessary surgery in many subjects with suspicious microcalcifications, although it implies a non negligible risk of false negative report. Surgical biopsy in VAB negative cases could be indicated according to other variables (e.g. the degree of radiological suspicion). VAB has relevant limits in grading breast lesions, as ADH or DCIS are associated to a considerable risk of upgrading at surgical biopsy. VAB reports other than INV need to be confirmed at surgery before an individual treatment strategy may be defined.