目的

探讨超声引导下空芯针穿刺活组织检查(CNB)病理学诊断非恶性乳腺病变的处理方法。

方法

回顾性分析2009—2013 年北京市顺义区妇幼保健院1 105 例CNB 诊断非恶性乳腺病变患者的临床和随访资料。 分类变量组间率的比较采用Pearson χ² 检验或Fisher 精确概率法。

结果

全部1 105 例研究对象CNB 诊断均为非恶性,其中477 例接受了手术切除,9 例术后病理诊断为乳腺癌,其余628 例定期乳腺超声或/和X 线摄影随访,在9 ～65 个月(中位随访36 个月)的随访期间无乳腺癌发生。 在行手术切除的患者中,CNB 诊断高危(59 例)和良性病变组(418 例)分别有7 例(11.9%)和2 例(0.5%)术后病理确诊为乳腺癌,高危病变组患乳腺癌的风险是良性病变组的28.0 倍(OR=28.0,95%CI:5.7 ～134.0,P=0.000)。 CNB 诊断为良性且行手术切除的418 例中,临床初诊与CNB 诊断不符的患者术后确诊为乳腺癌的比例为3.6%(2/56),高于临床初诊与CNB 诊断相符者的0(0/362),差异有统计学意义(P=0.018)。

结论

乳腺病变CNB 诊断非恶性病例中,除少数高危病变及临床初诊与病理不符者需手术切除外,大多数良性病变采用定期临床体检和影像学检查进行随访可能也是一种相对安全的处理方式。

Objective

To explore the management of non-malignant breast lesions in ultrasound-guided core needle biopsy (CNB).

Methods

The clinical and follow-up data of 1105 patients with non-malignant breast lesions diagnosed by CNB in Shunyi Health Care Hospital for Women and Children,Beijing,China,from 2009 to 2013 were retrospectively reviewed.Pearson χ² test or Fisher exact test was used for comparison of rates between groups.

Results

All 1 105 cases were diagnosed with non-malignant lesion by CNB.Among them,477 cases underwent surgery (including 9 cases diagnosed with breast cancer in postoperative pathological diagnosis), the remaining 628 cases were followed up by mammography or breast ultrasound for 9-65 months and no breast cancer was observed.Among the patients who underwent surgery,7 cases (11.9%) in high-risk lesion group and 2 cases (0.5%) in benign lesion group were diagnosed with breast cancer in postoperative pathological diagnosis respectively; the risk of breast cancer in high-risk lesion group was 28.0-fold as high as that in benign lesion group (OR=28.0, 95%CI: 5.7-134.0, P=0.000).Among 418 patients with benign lesions who underwent surgical excision, 2 cases were diagnosed with breast cancer postoperatively in the 56 patients with discordance between clinical examination and CNB (3.6%,2/56),no breast cancer was found in 362 patients with concordant diagnosis (0/362), and the difference was statistically significant (P=0.018).

Conclusion

In the patients with non-malignant lesions in CNB diagnosis,except a few patients in high risk or with discordant diagnosis between clinical examination and CNB who requiring surgical resection, periodic clinical breast examination and breast imaging follow-up may be a relatively safe management for most patients.