《中国微创外科杂志》第9期全文（24-8）空芯针穿刺活检在乳腺导管内乳头状肿瘤

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空芯针穿刺活检在乳腺导管内乳头状肿瘤中的诊断价值张春禹雪 张永辉付芬芬张冬洁谢凌铎褚福涛栗辰 王芹芹 徐硕 解云涛（北京大学国际医院乳腺外科，北京102206）

【摘要】目的探讨超声引导下空芯针穿刺活检（core needle biopsy，CNB）在乳腺导管内乳头状肿瘤中的诊断价值。方法回顾性分析我科9月~12月CNB诊断为导管内乳头状肿瘤46例48个病灶的资料，与手术切除病理进行对比。结果CNB诊断良性导管内乳头状瘤34个（70.8%），非典型导管内乳头状瘤10个（20.8%），导管内乳头状癌4个（8.3%）。除5个良性、1个非典型导管内乳头状瘤拒绝手术外，其余42个病灶行手术切除。CNB病理为良性导管内乳头状瘤，术后恶性病变所占比例为3.4%（1/29，浸润性导管癌1例）；穿刺病理为非典型导管内乳头状瘤，术后恶性病变所占比例为44.4%（4/9，均为浸润性乳腺癌）。CNB诊断导管内乳头状癌4例术后病理为浸润性癌3例，原位癌1例。拒绝手术的6例（6个病灶）随访时间8~20个月，中位时间17个月，病灶较前无明显变化。结论对于乳腺导管内乳头状肿瘤，CNB存在一定的低估可能，尤其当穿刺病理为非典型导管内乳头状瘤时，应积极手术切除活检，以避免遗漏恶性病变。

【关键词】空芯针穿刺活检；乳腺导管内乳头状肿瘤；低估

Diagnostic Value of Core Needle Biopsy in Breast Intraductal Papillary TumorsZhang Chun, Yu Xue, Zhang Yonghui, et al. Department of Breast Surgery, Peking University International Hospital, Beijing 102206, China

【Abstract】 ObjectiveTo explore the diagnostic value of ultrasound guided core needle biopsy (CNB) in breast intraductal papillary tumors.MethodsClinical >ResultsAccording to the CNB pathological results, there were 34 lesions (70.8%, 34/48) of benign intraductal papilloma, 10 lesions (20.8%, 10/48) of atypical intraductal papilloma, and 4 lesions (8.3%, 4/48) of intraductal papillary carcinoma. Except for 5 cases of benign papilloma and 1 case of atypical intraductal papilloma who refused operation, the other 42 lesions underwent surgery. For those with CNB pathology as benign intraductal papilloma, the proportion of malignant lesions after operation was 3.4% (1/29, 1 case of invasive ductal carcinoma). For those with CNB pathology as atypical intraductal papilloma, the proportion of malignant lesions after operation was 44.4% (4/9, all invasive breast cancer). For 4 cases of intraductal papillary carcinoma diagnosed by CNB, postoperative pathology included invasive carcinoma in 3 cases and carcinoma in situ in 1 case. Six patients (6 lesions) who refused surgery were followed up for 8-20 months, with a median of 17 months. There was no significant change in the lesions.ConclusionsFor breast intraductal papillary lesions, a certain underestimation of CNB does exist, especially when the pathology result of CNB is atypical intraductal papilloma. Surgical resection should be encouraged to avoid missing malignant lesions.

【Key Words】Core needle biopsy;Breast intraductal papillary tumor;Underestimation

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