目的

探讨空芯针穿刺活组织检查（CNB）病理诊断为乳腺纤维上皮性肿瘤（FT）患者的最佳治疗策略。

方法

回顾性分析2017 年1 月至2023 年5 月北京大学国际医院乳腺外科经CNB 诊断为FT 的783 例患者。 根据临床处理方法分为2 组：657 例患者（83.9%）为手术组，126 例患者（16.1%）为随访组。 比较2 组患者的临床特征和超声检查特征，评估手术组患者术后病理和临床特征的关系，以及随访组患者的自然病程及其影响因素。 年龄的组间比较采用独立样本t 检验，多组比较采用方差分析，并使用LSD-t 检验进行事后两两比较。 病变最长径的两组比较采用Mann-Whitney U 检验，多组比较采用Kruskal-Wallis H 检验，进一步两两比较采用Dunn-Bonferroni 检验。 临床特征、超声检查特征的多组间比较采用χ²检验或Fisher 确切概率法，两两比较采用Bonferroni 校正。

结果

手术组与随访组患者的年龄（t＝7.106，P＜0.001）和乳腺癌家族史（χ² ＝4.581，P ＝0.032）比较，差异有统计学意义。 2 组患者的超声检查特征比较，发现在病变形态不规则（χ² ＝12.127，P＜0.001）和BI-RADS 分类≥4B（χ² ＝35.116，P＜0.001）2 个方面差异有统计学意义。 手术组的术后病理显示：559 例（85.1%）为纤维腺瘤，84 例（12.8%）为良性叶状肿瘤（PT），14 例（2.1%）为非良性PT。 病变病理类型与是否可触及肿块（χ² ＝9.252，P＝0.010）和病变的最长径（超声：H＝9.267，P＜0.001；病理：H＝8.421，P＜0.001）具有相关性。 随访组中，83 例（65.9%）患者病变稳定，43 例（34.1%）患者病变最长径增加。 年长患者（≥40 岁）病变更倾向于保持稳定（χ2 ＝4.948，P＝0.026）。 随访期间改行手术的11 例患者，病理诊断均为良性病变。

结论

大部分经CNB 诊断为FT 患者可通过门诊随访免除不必要的手术。 对于直径大于3 cm、有症状、快速增大或BI-RADS 分类≥4B 的患者，手术是合理的选择。

Objective

To explore the optimal treatment strategy for patients diagnosed with fibroepithelial tumor （FT） through core-needle biopsy （CNB）.

Methods

A retrospective analysis was conducted on clinical data of 783 patients diagnosed with FT via CNB in the Department of Breast Surgery，Peking University International Hospital from January 2017 to May 2023. Patients were divided into two groups based on clinical management： the surgery group with 657 patients （83.9%） and the follow-up group with 126 patients （16.1%）. Clinical and ultrasound characteristics were compared between the two groups， and the relationship between postoperative pathology and clinical features in the surgery group， and the natural progression and influencing factors in the follow-up group， were evaluated. Independent sample t-test was used to compare age between groups， and variance analysis was used for multiple group comparisons with LSD-t tests for post-hoc pairwise comparisons. The maximum lesion diameter was compared between two groups using Mann-Whitney U test， between multiple groups using Kruskal-Wallis H test， followed by Dunn-Bonferroni tests for pairwise comparisons. Group comparisons of clinical and ultrasound characteristics were conducted using the chi-square test or Fisher’s exact test， with pairwise comparisons using Bonferroni correction.

Results

There were statistically significant differences in age （t＝7.106，P＜0.001） and family history of breast cancer （χ² ＝4.581， P＝0.032） between the surgery group and follow-up group. In ultrasound characteristics， significant differences were found in the cases with lesion irregularity （χ² ＝12.127， P＜0.001） and BI-RADS grade ≥4B（χ2 ＝35.116， P＜0.001） between the two groups. Postoperative pathology in the surgery group revealed 559 cases （85.1%） of fibroadenoma， 84 cases （12.8%） of benign phyllodes tumor （PT）， and 14 cases （2.1%）of non-benign PT. The pathological type of the lesion was associated with palpable masses （χ² ＝9.252，P＝0.010） and maximum lesion diameter （ultrasound： H ＝9.267， P ＜0.001； pathology： H ＝8.421，P＜0.001）. In the follow-up group， 83 patients （65.9%） had stable lesions， while 43 patients （34.1%）showed an increase in maximum lesion diameter. Older patients （≥40 years） were more likely to have stable lesions （χ² ＝4.948， P ＝0.026）. All 11 patients who underwent surgery during the follow-up were diagnosed with benign lesions.

Conclusions

Most of the CNB-diagnosed FT patients can avoid unnecessary surgery through outpatient follow-up. Surgery is a reasonable option for patients with lesions which were larger than 3 cm， symptomatic， rapidly growing， or classified as BI-RADS grade ≥4B.