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目的 用微小介入的方法针取乳房组织进行活检，医师不开刀手术就能取得足量乳房组织进行确定诊断。方法 Mammotone微创活检系统在乳房肿块活检诊断系统进行取材，将探讨单次置入乳房的病灶中利用该系统的真空抽吸辅助装置和特殊的旋转设计，将病灶吸附于管腔内，再用传送装置将管状刀送入管腔内，将病灶取出，结果 88例病人，102处病灶中，恶性31处，良性71处，其中纤维腺瘤28处，乳腺增生或增生性腺瘤43处，34处小于2cm病灶被完全取除，其余68处病灶均经手术切除并复送病理，与活检符合率为97.1%。结论 经皮微创穿刺乳房肿块活检是目前定性诊断乳腺病变的理想方法。在临床实际工作中应根据具体条件和需要与传统方法选择应用。     

Fine needle aspiration cytology in lieu of open biopsy in management of primary breast cancer.

Fine needle aspiration (FNA) can be used in place of open breast biopsy in most patients with primary breast cancer. This report summarizes our experience with 398 patients who had FNA of the breast. There was a total of 136 cancers, of which 100 (74%) were diagnosed by FNA. Seventy-one patients had mastectomy without frozen section. Thirteen had an excisional biopsy before mastectomy by preference of the surgeon. These cases occurred early in this series, before the surgeons became confident in the technique. The presence of locally advanced disease was confirmed by FNA in 12 patients and metastases to the breast were confirmed in four. There were no false-positives. Fine needle aspiration was interpreted as "suspicious" but not diagnostic of malignancy in 31 patients and open biopsy was requested. Biopsies demonstrated primary breast carcinoma in 22 patients and metastatic cancer in one. There were 103 patients with FNA negative for cancer who had open biopsy; 102 were confirmed negative, and one was positive for cancer. Fine needle aspiration yielded insufficient material in 38 patients, and 12 of these were found to have carcinoma with open biopsy. Advantages of FNA: It is safe, atraumatic and rapid, and permits definitive discussion about treatment planning at the initial office visit. It obviates the need for frozen section, reducing anesthesia and operative time. Our experience shows that FNA is highly accurate in the diagnosis of breast malignancy if rigorous criteria are used. Although a negative FNA requires biopsy to exclude malignancy, a FNA that is positive for cancer eliminates the need for open biopsy and allows the surgeon to proceed to mastectomy with confidence.     

Sarcoidosis of the breast: implications for the general surgeon

Sarcoidosis is a multisystemic disease that may involve the breast parenchyma and can be confused with benign or malignant tumors. A recent case of sarcoidosis of the breast treated in our institution prompted us to review the world literature on the topic. From 1921 to 1997, 45 cases relating to sarcoidosis of the breast were reported; 10 of these cases were excluded from our review because of the lack of histological proof of sarcoidosis. The data were organized according to clinical presentation, diagnostic studies, treatment plan, and follow-up care. The mean age at presentation was 47 years (range 20-72 years) and all patients were female. Seven patients (20%) had a breast mass as primary presentation of sarcoidosis without any clinical evidence of systemic sarcoidosis. Thirty-one patients (89%) presented with a self-detected mass and three patients (8%) demonstrated skin dimpling and peau d'orange appearance mimicking cancer. The size of the breast lesions ranged from 0.25 to 5 cm in diameter. One patient presented with bilateral breast lesions and one with more than one lesion in the same affected breast. A single breast mass was found in the rest of the patients. Of the seven patients evaluated by mammography, only one revealed changes suspicious for malignancy. Fine-needle aspiration was used only in four cases; the results of two were compatible with sarcoidosis and two required an excisional biopsy as a result of inconclusive results. Seventeen cases reported excisional biopsy as the diagnostic procedure. In 11 patients the type of biopsy was not stated. In two cases of radical mastectomies for breast adenocarcinoma, sarcoidosis was an incidental finding, either in the remaining breast tissue or in the axillary nodes. One patient underwent a partial mastectomy revealing sarcoidosis as the definitive diagnosis. Ultrasound was used in two cases; one revealed a suspicious lesion and one was inconclusive. Although sarcoidosis of the breast constitutes a rare entity it should be considered in the differential diagnosis of breast cancer even in patients without clinical evidence of systemic sarcoidosis. These patients should undergo a biopsy to rule out malignancy because clinical findings, mammography, and ultrasound results can be misleading or inconclusive.     

Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): a large multi-institutional study in Italy

Percutaneous core biopsy (CB) has been introduced to increase the ability of accurately diagnosing breast malignancies without the need of resorting to surgery. Compared to conventional automated 14 gauge needle core biopsy (NCB), vacuum-assisted needle core biopsy (VANCB) allows obtaining larger specimens and has recognized advantages particularly when the radiological pattern is represented by microcalcifications. Regardless of technical improvements, a small percentage of percutaneous CBs performed to detect breast lesions are still classified, according to European and UK guidelines, in the borderline B3 category, including a group of heterogeneous lesions with uncertain malignant potential. We aimed to assess the prevalence and positive predictive values (PPV) on surgical excision (SE) of B3 category (overall and by sub-categories) in a large series of non-palpable breast lesions assessed through VANCB, also comparison with published data on CB. Overall, 26,165 consecutive stereotactic VANCB were identified in 22 Italian centres: 3107 (11.9%) were classified as B3, of which 1644 (54.2%) proceeded to SE to establish a definitive histological diagnosis of breast pathology. Due to a high proportion of microcalcifications as main radiological pattern, the overall PPV was 21.2% (range 10.6%-27.3% for different B3 subtypes), somewhat lower than the average value (24.5%) from published studies (range 9.9%-35.1%). Our study, to date the largest series of B3 with definitive histological assessment on SE, suggests that B3 lesions should be referred for SE even if VANCB is more accurate than NCB in the diagnostic process of non-palpable, sonographically invisible breast lesions.     

Ultrasound-guided Tru-cut biopsy of the breast.

Ultrasound-guided automated Tru-cut needle biopsy may be used as an alternative to fine needle aspiration cytology for the assessment of discrete mass lesions of the breast. This is a retrospective study of 187 biopsies, comparing the results with a final diagnosis obtained from subsequent excision or outpatient follow-up. Biopsies were performed using a spring-loaded gun under ultrasound guidance. Invasive malignancy was demonstrated in 114 biopsies, 98 of which were subjected to surgery, with no false-positives. Twelve biopsies contained 'atypical cells', pre-invasive malignancy or risk factors for invasive carcinoma, ten of which proved to be invasive malignancy on excision. Normal or benign tissue was found in 61 biopsies, but of those that proceeded to excision biopsy, 16 were invasive or in situ carcinoma. The sensitivity of the procedure for detecting significant pathology was 88.7%, and the specificity 100%. When used as part of triple assessment, the sensitivity increases to 97.9%. Ultrasound-guided Tru-cut needle biopsy is a well-tolerated and reliable procedure for providing a tissue diagnosis of malignancy before definitive treatment, and obviating the need for formal excision biopsy of lesions for which there is a low index of suspicion.     

A simple approach to nipple discharge

Evaluation and management of patients with nipple discharge (ND) aims to identify carcinoma when present, and in benign cases, stop the discharge when bothersome. We reviewed our recent experience with ND to develop a simple and effective algorithm to manage these patients. Records of all patients with ND evaluated from December 1996 through June 1999 were reviewed. Patients were liberally offered duct excision for a clinical suspicion of malignancy (persistent clear or bloody fluid) or to stop bothersome discharge. Patients with breast imaging abnormalities (mammography or ultrasound) related to their ND underwent biopsy and were considered separately. Of 104 patients with ND, 11 underwent biopsy as a result of mammographic findings; three of these cases proved malignant. The remaining 93 patients were evaluated with 55 tests that did not demonstrate malignancy, including ductography, discharge fluid cytology, serum prolactin and thyroid-stimulating hormone levels, and image-guided breast or nipple biopsy. Thirty-nine patients underwent duct excision with only a single patient demonstrating malignancy. Clinical follow-up has not identified malignancy in any patient managed nonoperatively. When diagnostic breast imaging is negative, malignancy related to ND is uncommon. Patients with ND should have diagnostic breast imaging and, if it is negative, should be offered duct excision. There is little role for ductography, cytology, or laboratory studies in evaluating these patients.     

Needle core biopsy for the assessment of unilateral breast masses in men

Although unilateral male breast swelling is relatively common, a histological diagnosis is infrequently obtained. From 1998 to 2003 we routinely performed needle core biopsy on all men presenting with unilateral breast swelling in whom there was diagnostic uncertainty. Of 113 patients, 93% had gynaecomastia, two patients had primary breast cancer and one had metastatic lymphoma. One patient had chronic mastitis. Gamolenic acid treatment produced a 73% response rate amongst patients presenting with pain. Core biopsy is a safe and effective method of diagnosing unilateral male breast swelling, which allows either confident reassurance or definitive treatment of those with cancer or pain.     

Radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy: analysis of 49 cases from a single-centre and review of the literature

The purpose of this study was to evaluate the reliability of image-guided 14-gauge needle core biopsy in the diagnosis of radial scar without associated atypical epithelial proliferation, by comparison with definitive histological diagnosis on surgical excision. The records of 8792 consecutive image-guided 14-gauge needle core biopsy of the breast performed from January 1996 to December 2009 were reviewed. Forty-nine cases of radial scar without associated atypical epithelial proliferation were identified and compared with definitive histological diagnosis on surgical excision. The definitive histological diagnosis on surgical excision confirmed the results of image-guided 14-gauge needle core biopsy in 36 of 49 cases (73.5%), in 9 cases (18.3%) radial scar was associated with atypical epithelial proliferation, while 4 cases out of 49 cases were upgraded to carcinoma (3 cases of ductal carcinoma in situ and one case of invasive lobular carcinoma), with an underestimation rate of 8.2%. A diagnosis of radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy does not exclude a malignancy on surgical excision; consequently during the multidisciplinary discussion further assessment by surgical excision or vacuum-assisted excision, as recently reported, needs to be considered to obtain a definitive histological diagnosis.     

Imaging-Guided Core Biopsy of the Breast

Abstract: This article reports on our experience with core needle biopsy (CNB) of the breast and presents a review of the literature. We have performed CNB on 304 women with abnormalities classified on imaging as highly suggestive of malignancy (52 cases), suspicious (245 cases) or probably benign (7 cases). The CNB procedure was performed using either stereotactic mammographic guidance (251 cases) or ultrasound guidance (53 cases) with a 14-gauge needle. At least five specimens were obtained for each abnormality. The sensitivity of core biopsy was 98% and the specificity was 99%. There were three false negatives and one false positive. An excisional biopsy was recommended in 17 cases in which the CNB diagnosis was not definitive, including 12 with atypical ductal hyperplasia (ADH), 4 with discordance between imaging and histologic results, and 1 with inconclusive histology. Our results are consistent with other reports in the literature using 14-gauge core needle biopsy. In our practice, core biopsy has proven to be an effective method for the evaluation of imaging findings that are suspicious or highly suggestive of malignancy.     

Two cases of retrovesical haematoma following prostatic biopsy

Prostatic biopsy is a definitive diagnostic method that should be used whenever a prostatic malignancy is suspected. Anatomically it can be done from the transrectal or perineal route. In two methods transrectal ultrasonography can be used as a helper tool. In this paper we present two cases of pelvic haematoma following prostatic biopsy that occasionally cause complications.     

Sentinel node biopsy for nonpalpable breast tumors requires a preoperative diagnosis of invasive breast cancer

A sentinel node biopsy done at the time of initial tumor resection allows for a one-stage surgical procedure. In addition, sentinel node identification may be impaired when done after a previous tumor excision. This study evaluates the sentinel node biopsy in patients with nonpalpable breast cancer and assesses whether a sentinel node biopsy for mammographically suspect breast lesions is justified when preoperative needle biopsy is inconclusive for invasive malignancy. A sentinel node biopsy was done in 67 patients with nonpalpable breast lesions after injection of radioactive tracer (intraparenchymal in 35 and subdermal in 32) and blue dye (para-areolar). A preoperative core needle biopsy was positive for malignancy in 42 patients. Thirteen patients had positive cytology or ductal carcinoma in situ (DCIS). In 12 patients the needle biopsy was nondiagnostic, but the lesions remained highly suggestive of malignancy on mammography. Sentinel node biopsy was successful in 64 patients (96%). In these, the sentinel node was both radioactive and blue in 58 patients (91%). Only 4 of 13 patients with positive cytology or DCIS on preoperative needle biopsy and only 5 of 12 patients without a preoperative diagnosis had an invasive cancer after resection. Sentinel nodes were positive for nodal metastases in 9 of 49 patients (18%) with a successful sentinel node biopsy for invasive malignancy. None of the eight patients with DCIS had nodal metastases. The sentinel node procedure avoids the potential morbidity of an axillary dissection in more than 80% of patients with nonpalpable breast cancer. A sentinel node biopsy for mammographically detected suspect breast lesions is not justified without a preoperative histologic diagnosis of invasive breast cancer.     

Imaging Guided Biopsy: An Alternative to Surgical Biopsy

Imaging guided percutaneous core needle biopsy of the breast is an accurate and cost-effective method for the diagnosis of indeterminate breast lesions. It is also useful for the preoperative confirmation of suspected carcinoma. Depending on the location of the lesion in the breast, its imaging characteristics, and the configuration of the breast, biopsy using sonographic or stereotactic guidance may be preferable. However, for many lesions either technique can be used. A variety of biopsy probes are available. For many lesions the ability to make a diagnosis does not appear to depend on the probe size or configuration. However, when calcifications undergo biopsy, the retrieval of larger volumes of tissue may improve the accuracy of the diagnosis of atypical ductal hyperplasia (ADH), ductal carcinoma in situ (DCIS), and other rare lesions. Major complications are rare with these techniques. With benign histologies, most patients can avoid surgery and return to 6-month follow-up or routine screening mammography. When benign histologies are not concordant with the imaging pattern, when certain high-risk lesions are found at core biopsy, and when the pathologist is unable to make a definitive diagnosis based on the small volume of tissue removed, surgical biopsy is necessary. However, the vast majority of patients with benign diagnoses can avoid surgery with these biopsy techniques. It should be remembered that these techniques are not appropriate for the treatment of breast carcinoma at the present time.     

THE CONSULTANT SURGEON AND MAMMOGRAPHY

It is important that the mounting wave of criticism of mammography in breast screening programmes should not obscure the fact that it remains the most accurate method of diagnosing breast cancer short of biopsy. Furthermore, breast cancer may be diagnosed by mammography at an early stage before it has spread to regional lymph nodes, at a time when the prognosis is better. At this time it may be beneficial to outline the role of mammography as an aid to the consultant surgeon in the management of patients referred with breast problems.     

Spontaneous breast cancer remission: A case report

IntroductionSpontaneous breast cancer remission is a rare phenomenon. We report the disappearance from the remaining breast of a new primary carcinoma that had been confirmed through cytology of a pathological specimen, in a case that is strongly suspected to be spontaneous remission.Presentation of caseA 44-year-old woman underwent breast-conserving surgery for a tumor located on the border between the upper-outer and lower-outer quadrants of the left breast (T2, N1, M0; Stage IIB). Eleven years after surgery, computed tomography indicated a mass in the upper-inner quadrant of the left breast. Excisional biopsy was initially planned for treatment following the definitive diagnosis because cytology revealed malignancy. The patient had noticed tumor regression one month after fine-needle aspiration and repeat ultrasonography performed the day before excisional biopsy confirmed the tumor reduction. On pathological examination, no tumor cells were observed in the mass.DiscussionThere was a discrepancy between FNA cytology and pathological diagnosis in our patient. The cytological findings indicated malignancy, but the pathological findings did not. When a tumor’s pathological diagnosis is not malignant even though its FNA cytology diagnosis was malignant, sampling error, cytological over-diagnosis or some other error may have occurred. In this case, however, these were not detected. Because fibrosis was visible on pathological examination, we believe that these events corresponded to spontaneous remission.ConclusionWe report a rare case of spontaneous remission in which the cancer disappeared on pathological examination although the cytological diagnosis had been malignant.     

The consultant surgeon and mammography.

It is important that the mounting wave of criticism of mammography in breast screening programmes should not obscure the fact that it remains the most accurate method of diagnosing breast cancer short of biopsy. Furthermore, breast cancer may be diagnosed by mammography at an early stage before it has spread to regional lymph nodes, at a time when the prognosis is better. At this time it may be beneficial to outline the role of mammography as an aid to the consultant surgeon in the management of patients referred with breast problems.     

The role of needle biopsy in the diagnosis of breast lesions

14G core biopsy has contributed enormously to the pre-operative diagnosis of breast malignancy, although it is still subject to certain shortcomings. It is important to review core biopsy results in a multidisciplinary environment, especially when dealing with benign results, to minimize the potential for false negative cases. In certain circumstances, FNAC (fine needle aspiration cytology) still has an important part to play although this is very much dependent upon local circumstances. Decisions about the relative values of FNAC and core biopsy should be taken by the multi-disciplinary breast team within the context of its own results and practice, but should the use of FNAC be continued, the maintenance of the relevant expertise is of major importance. Vacuum assisted breast biopsy instruments should further increase the rate of preoperative diagnosis of impalpable lesions considered suspicious on mammography.     

Stereotactic breast biopsy as an alternative to open excisional biopsy

Background: Health care cost continues to play a dominant role in our society. Technological advances are expensive, with the possible exception of stereotactic breast biopsy. We must learn other alternatives that give the same diagnostic accuracy at lower cost. The intention of this study was to find other acceptable alternatives to open excisional breast biopsies. Methods: Patients were referred to Baylor University Medical Center betwee between May 1990 and June 1992 for stereotactic breast biopsy of nonpalpable mammographic abnormalities. Before stereotactic biopsy, lesions were categorized into low or high suspicion for malignancy based on screening mammography. Slides were reviewed by a pathologist and the histological diagnosis was compared with mammographic characterization. Benign histology confirming the low-suspicion mammographic abnormality demonstrated mammographic and histologic correlation. Mammographic follow-up was recommended. Results: Two hundred twenty-five women underwent 250 stereotactic breast biopsies. Malignancy was diagnosed in 47 patients; the remaining 203 lesions were benign on pathological examination and are being followed regularly. Seventy-eight percent of the lesions were characterized as low suspicion for malignancy, and 22% were characterized as high suspicion. The average cost saving per lesion using stereotactic biopsy was $1,629. Conclusion: Stereotactic breast biopsy is an acceptable, less expensive alternative to open excisional biopsy for diagnosing nonpalpable mammographic findings. Results of this study were presented at the 46th Annual Cancer Symposium of the Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

Recent trends in the management of breast cancer. 2.Occult breast lesions: when and how to perform a biopsy for mammographic abnormalities.

In 1989 the Canadian Cancer Society recommended that women over 50 years of age should undergo mammography as a test for breast cancer in centres dedicated to such programs. This recommendation and others by American societies have increased the number of mammographies done for screening purposes. As a result many mammographic abnormalities are reported by radiologists, who recommend biopsy. The surgeon should review the films with the radiologist and ensure that the anomaly is real. Attention should be given to specific signs of cancer, such as spiculated lesions; however, nonspecific signs of cancer, such as microcalcifications, microlobulation and architectural distortion, should be evaluated carefully before biopsy is carried out. Stereotaxic fine-needle aspiration can decrease the number of surgical biopsies needed. The surgical biopsy should be a one-step, segmental mastectomy done for diagnosis and treatment. The specimen should be oriented, inked and x-rayed and a definitive diagnosis made on paraffin blocks. Frozen sections should not be made of microcalcifications.     

Final diagnosis by fine-needle aspiration biopsy for definitive operation in breast cancer

This work has been based on 15 years experience with more than 10,000 needle aspiration biopsies of the breast. Fine-needle aspiration biopsy was used in place of open breast biopsy for definitive operation in breast cancer. Our experience with 2,623 aspiration biopsies over a 3 year period has been reviewed. There was a total of 323 cancers, of which 257 (80 percent) were unequivocally diagnosed by fine-needle aspiration biopsy. Definitive operation was performed in 244 of these patients (95 percent) without open biopsy. Thirteen had an excisional biopsy before definitive operation at the request of the referring physician. The sensitivity was 80 percent and the specificity was 98 percent. There were no false-positive diagnoses. The positive predictive value was 100 percent. False-negative diagnoses were made in 9 percent of the patients, half of whom had nonpalpable carcinomas. Our experience shows that fine-needle aspiration biopsy is accurate in the diagnosis of breast cancer, and when the finding is positive, it can be used for definitive breast operation, eliminating the need for open biopsy. A management algorithm has also been presented herein.     

Can preoperative factors predict for residual malignancy after breast biopsy for invasive cancer?

The presence of malignancy at the resection margins of a malignant breast biopsy requires difficult therapeutic decisions about whether a re-excision biopsy is necessary. The aim of this study was to determine the factors predisposing to the involvement of the resection margins in 280 women undergoing breast biopsy for invasive malignancy from a single breast screening practice. Resection margins were assessed independently by a single pathologist who noted either the presence of tumour at the margins of the biopsy specimen or in the shavings taken from the biopsy cavity. Resection margin involvement (RMI) occurred in 113 patients. Mammographic microcalcification (MM) was seen in 87 women with invasive cancer and RMI occurred in 53 (61%) compared with 60/193 invasive cancers without MM (P < 0.001). If RMI was present the patients underwent a second procedure to ensure complete tumour excision, and 68% of re-excision specimens from tumours with MM and 36% of tumours without MM contained residual malignancy (P < 0.005). Statistical analysis demonstrated that these observations were independent of tumour size, grade, type, and axillary node status. The presence of mammographic microcalcification therefore indicates that wider than usual surgical resection margins should be taken.