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目的:计算乳腺空芯针穿刺活检(core needle biopsy,CNB)诊断为不典型导管上皮增生(atypical ductal hyperplasia,ADH)病人的病理低估率。分析病人临床及影像学信息,探讨低估的预测因素。方法:回顾性分析2010年1月至2013年2月期间,本中心60例CNB诊断为ADH病人。定义病理低估为CNB是ADH但切除活检诊断是恶性的。以卡方检验、Fisher精确检验和二分类Logistic回归分析病理低估的预测因素。结果:本研究60例CNB诊断为ADH病人的病理低估率为65.0%(39/60)。乳腺X线检查发现恶性征象的微钙化(OR=7.988,95%CI:4.997~12.810,P=0.001)、乳腺X线检查影像报告数据系统(BI-RADS)≥4级(OR=10.875,95%CI:2.747~43.051,P<0.001)和乳腺磁共振检查BI-RADS 5级(OR=10.000,95%CI:1.183~84.504,P=0.034)是提示病理低估的预测因素,其中乳腺X线检查发现恶性征象的微钙化(OR=5.613,95%CI:1.032~30.539,P=0.046)是提示病理低估的独立预测因素。结论:CNB诊断为ADH病人的病理低估率较高,需考虑予以手术切除活检。特别是伴有危险因素的病人,更应重视。乳腺磁共振对ADH的病理低估有一定预测作用。
OBJECTIVE: To calculate the pathological underestimation rate of atypical ductal hyperplasia (ADH) diagnosed by core needle biopsy (CNB). Analysis of patient clinical and imaging information to explore the underestimated predictors. Methods: A retrospective analysis of January 2010 to February 2013 period, the center of 60 cases of CNB diagnosis of ADH patients. The definition of pathology is underestimated as CNB is ADH but excisional biopsy diagnosis is malignant. Chi- square test, Fisher exact test and dichotomous Logistic regression were used to analyze the predictors of pathological under-estimation. Results: The pathological underestimation rate of 60 patients with CNH diagnosed as ADH in this study was 65.0% (39/60). Mammography showed microcalcifications (OR = 7.988, 95% CI: 4.997-12.810, P = 0.001) for malignant features, grade 4 (BI = RADI) % CI: 2.747 ~ 43.051, P <0.001) and breast biopsy BI-RADS grade 5 (OR = 10.000,95% CI: 1.183 to 84.504, P = 0.034) were predictors of pathological under- The presence of micro-calcifications (OR = 5.613, 95% CI: 1.032-30.539, P = 0.046) for the detection of malignant signs was an independent predictor of pathologic underestimation. Conclusion: The pathological underestimation rate of patients with CNH diagnosed as ADH is high, and surgical biopsy should be considered. In particular, patients with risk factors should pay more attention. Breast magnetic resonance imaging of ADH pathological underestimation have a certain predictive effect.