【摘要】 目的 明确超声引导下空芯针穿刺活检（CNB）诊断的单纯型乳腺导管内乳头状瘤（IDP）的术后升级率并识别术后升级为恶性的潜在预测因素，以提高诊断准确性并优化临床决策。方法 回顾性纳入经超声引导下CNB确诊的单纯型IDP女性病人114例，平均年龄（45.8±9.3）岁，共114个病灶；根据术后病理结果将病人分为良性组（108例）与恶性组（6例）。其中，78例额外行超声引导细针抽吸活检（US-FNA）的病人也根据病灶病理结果分为良性组（73例）与恶性组（5例）。采用Welch’s t检验、Fisher确切概率检验比较良恶性组间临床、影像学及病理学特征并进行单因素Logistic回归分析，将2种方法分析结果均有统计学意义的特征进一步行多因素Logistic回归分析以筛选术后升级为恶性的独立预测因素。结果 114例单纯型IDP中，6例（5.3%）术后病理升级为恶性。经组间比较和单因素Logistic回归分析，良恶性组间病人年龄、US-FNA、病灶最大径、微钙化、超声BI-RADS分类及超声-病理一致性的差异均有统计学意义且与恶性升级有一定的相关性（均P<0.05）。进一步多因素Logistic回归分析显示微钙化（OR=9.068,P=0.044）及US-FNA中发现非典型性/恶性/可疑恶性细胞（OR=19.956,P=0.036）为术后恶性升级的独立预测因素。结论 超声检查发现微钙化，以及US-FNA发现非典型性、可疑恶性或恶性细胞是IDP恶性升级的高危因素。US-FNA可有效降低CNB假阴性率，提高IDP的诊断准确性，指导临床治疗。更多还原

【Abstract】 Objective To determine the postoperative upgrade rate of pure intraductal papilloma(IDP) diagnosed by ultrasound-guided core needle biopsy(CNB) and identify potential predictors of malignant upgrade, aiming to improve diagnostic accuracy and optimize clinical decision-making. Methods This retrospective study included 114 female patients with pathologically confirmed pure IDP via ultrasound-guided CNB, with a mean age of 45.8±9.3 years and 114 lesions.Based on postoperative pathology, the patients were divided into a benign group(n=108) and a malignant group(n=6). Among them, 78 patients underwent additional ultrasound-guided fine-needle aspiration(US-FNA) and were similarly categorized into a benign group(n=73) and a malignant group(n=5) based on surgical pathology. Welch’s t-test and Fisher’s exact test were used to compare clinical, imaging, and pathological characteristics between benign and malignant groups. Univariate logistic regression analysis was performed. Characteristics showing statistically significant differences in the group comparisons and univariate Logistic regression were further analyzed using multivariate Logistic regression to identify independent predictors of postoperative malignant upgrade. Results Among the 114 pure IDP cases, six(5.3%) were upgraded to malignant postoperatively. Group comparisons and univariate logistic regression analysis showed statistically significant differences between benign and malignant groups in patient age, US-FNA, maximum lesion diameter, presence of microcalcifications, ultrasound BI-RADS category, and ultrasound-pathology concordance, with all these factors showing some correlation with malignant upgrade(P<0.05 for all). Multivariate Logistic regression analysis identified the presence of microcalcifications(OR=9.068, P=0.044) and the detection of atypical/malignant/suspicious cells on US-FNA(OR=19.956, P =0.036) as independent predictors of postoperative malignant upgrade. Conclusion Microcalcifications observed on ultrasound, and presence of atypical, suspicious malignant, or malignant/cells detected by FNA are high-risk factors for malignant upgrade of IDP. Ultrasound-guided FNA can effectively reduce the false-negative rate of CNB, improve diagnostic accuracy for IDP, and assist in clinical decision-making.更多还原