超声引导下空芯针穿刺活检对乳腺浸润性导管癌组织学分级的临床价值

目的:探讨超声引导下空芯针穿刺活检对乳腺浸润性导管癌组织学分级的临床价值。方法:回顾性分析我院就诊的临床病理资料完整的276例患者的资料。共302个病灶，均经超声引导下空芯针穿刺活检，术后病理证实为乳腺浸润性导管癌。每个病灶至少取3针。肿瘤级别的诊断依据是Bloom-Richardson组织学分级法。统计学方法应用科恩卡方检验，评估的内容包括低估率、高估率、不同大小(小肿瘤组:<1.0cm，中间组:1.0-2.5cm，大肿瘤组:>2.5cm)病灶的诊断符合率。结果:穿刺活检结果和术后病理结果的总体符合率为72.0%（simple κ=0.52；95%CI，0.38-0.61)，穿刺活检对Grade 3级的诊断符合率89.7%(61/68)，Grade 2级诊断符合率66.7%(120/180)，Grade 1级诊断符合率65.8%(25/38)。穿刺活检对浸润性导管癌的总体高估率22.0%，总体低估率5.9%。当肿瘤体积增大时，穿刺活检容易出现较高的低估率，大肿瘤组42.4%，中间组21.9%，小肿瘤组16.0%(P<0.003)。结论:超声引导下空芯针穿刺活检能够准确预测高级别浸润性乳腺导管癌，肿瘤体积的增大在一定程度上影响了穿刺活检的准确性，造成较高的低估率。

The clinical value of ultrasound guided core biopsy in diagnosing tumor grade of invasive ductal carcinoma of the breast

Objective:To evaluate the clinical value of ultrasound-guided core biopsy diagnosing tumor grade of invasive ductal carcinoma of the breast. Methods:We retrospectively studied 302 consecutive invasive ductal carcinomas （276 women) who were biopsied under ultrasound-guided，core needles exclusively.Core biopsy grades were compared with final surgical grades.The correlation between tumor size （small，<1.0cm；medium,1.0-2.5cm；and large，>2.5cm) and agreement rate was evaluated.Results:The overall agreement between core biopsy and surgical pathology grade was 72.0%（simple κ=0.52；95%CI，0.38-0.61).Agreement by biopsy grade was 89.7%（61/68)for grade 3，66.7%（120/180)for grade 2，and 65.8%（25/38)for grade 1.Core biopsy overestimated 22.0%（63/286)and underestimated 5.9%（17/286)of the lesions.When tumors is larger，they were more likely to show underestimation，42.4% for large，21.9% for medium，and 16.0% for small tumor (P<0.003).Conclusion:Ultrasound-guided core biopsy accurately predicts high-grade breast tumors.Large tumor size impacts the accuracy of tumor grade found on biopsy and is result to underestimation.