乳腺X线立体定位活检方法的评价及选择  

Stereotactic biopsy for non-palpable breast lesions:evaluation and choice of minimal invasive and excisional biopsy

作　　者：柳光宇[1] 陈灿铭[1] 胡震[1] 凌泓[1] 沈坤炜[1] 沈镇宙[1] 邵志敏[1] 

机构地区：[1]复旦大学附属肿瘤医院乳腺外科,上海200032

出　　处：《中华外科杂志》2006年第19期1322-1324,共3页Chinese Journal of Surgery

摘　　要：目的对目前乳腺 X 线立体定位下常用的3种活检方法进行评价。方法自2000年1月起,对361例乳腺病灶进行乳腺 X 线立体定位活检,其中弹射式空芯针活检(ST-CNB)73例、真空辅助旋切活检(ST-VAB)74例以及手术活检214例。在中位随访时间为18个月(6～66个月)时,比较3种 X 线立体定位活检方法的准确性以及临床应用特点。结果乳腺 X 线立体定位手术活检、ST-CNB 和 ST-VAB 诊断乳腺癌的漏诊率分别为0、2.7%和0。微创活检诊断乳腺导管上皮不典型增生的低估率为33%,诊断乳腺导管内癌的低估率为53%。微创活检在操作时间、对乳房外形的影响及并发症等方面明显优于手术活检。微创活检使69%的可疑病灶避免了手术。结论乳腺 X 线立体定位微创活检,尤其是真空辅助旋切活检是一种准确、安全、简便的诊断方法,因此可作为乳腺 X线中度可疑(BIRADS-4)病灶的首选诊断方法,但如果活检结果为不典型增生应进一步行 X 线立体定位手术活检;而对于高度可疑(BIRADS-5)病灶,宜直接选择手术活检诊断。Objective To evaluate three biopsy methods which are currently used in stereotactic breast biopsy. Methods A total of 361 cases of stereotactic breast biopsies were carried out since 2000, including 73 cases of true cut core needle biopsies （ST-CNB） , 74 cases of vacuum assisted biopsies （ ST- VAB） and 214 cases of excisional biopsies. After medium follow-up time of 18 months （6 to 66 months）, the accuracy as well as the clinical benefits of the three stereotactic biopsy procedures were analyzed retrospectively. Results The cancer miss rate of stereotactic wire localized excisional biopsy, ST-CNB and ST-VAB is 0,2. 7% and 0 respectively. Under-estimate rate of minimal invasive biopsy was 33% in atypical ductal hyperplasia （ADH） and 53% in ductal carcinoma in situ （DCIS）. The minimal invasive procedure is superior to surgical procedure in terms of operation time, breast cosmetic outcome and complications, etc. Furthermore, 69% of the surgeries for suspicious lesion were waived. Conclusions Stereotactic minimal invasive breast biopsy, especially ST-VAB, is an accurate, salty and convenient diagnosis technique and could be considered as the first line choice for mammographic moderate suspicious breast lesions （BIRADS- 4）. However, further excisional biopsy is recommended for atypical hyperplasia. Stereotactic excisional biopsy could be directly used for diagnosis of mammographic highly suspicious breast lesions （BIRADS-5）.

关 键 词：乳腺肿瘤 诊断 活组织检查 

分 类 号：R816.4[医药卫生—放射医学]