超声影像引导的乳腺病灶经皮穿刺组织病理学检查的临床应用  

Ultrasound-guided core needle biopsy in the diagnosis of breast lesions

作　　者：范照青[1] 欧阳涛[1] 王天峰[1] 李金锋[1] 解云涛[1] 范铁[1] 张喆[1] 林本耀[1] 

机构地区：[1]北京大学临床肿瘤学院北京肿瘤医院暨北京市肿瘤防治研究所乳腺癌预防治疗中心,100036

出　　处：《中华外科杂志》2007年第17期1185-1187,共3页Chinese Journal of Surgery

基　　金：北京市卫生局重点学科基金(1998卫科重字10号)

摘　　要：目的评价超声影像引导的乳腺病变经皮空芯针穿刺(CNB)组织病理检查方法的准确性及其影响因素。方法回顾性分析2000年1月至2006年5月收治的2152例乳腺病变患者经皮CNB组织病理检查结果及临床资料。比较穿刺与切除组织病理诊断之间的一致性,并对未进行切除活检的患者进行随访。结果在最终诊断为乳腺癌的1461例患者中,CNB 病理结果显示,乳腺癌1339例,假阴性率为3.5%(51/1461),低估率为4.9%(71/1461)。50.0%(17/34)的导管上皮非典型增生和46.3%(25/54)的乳头状病变在重新活检中诊断为癌。B 超引导 CNB 的假阴性率(2.1%,22/1068)显著低于徒手引导 CNB(7.4%,29/393)(P<0.05)。两名专责医师 CNB 的假阴性率(1.2%,8/681)显著低于非专责医师(5.5%,43/780)(P<0.05)。738例经 CNB 诊断良性病变中,417例进行手术切除活检,50例诊断为乳腺癌,205例良性病变随访2～29个月(中位随访时间10.2个月),发现1例恶性病变。结论超声影像引导的乳腺病灶经皮病灶穿刺组织病理检查是准确可靠的诊断方法。对于穿刺病理结果为高危病变者应予切除活检。Objective To evaluate the accuracy and utility of ultrasound-guided core needle biopsy （CNB） in the diagnoses of breast lesions. Methods The clinical data of 2152 consecutive breast lesions examined by CNB were reviewed. The histological agreement between core pathology and subsequent excision pathology was studied. The benign diseases without repeat biopsy were followed up. Results There were 1461 cancers in final diagnosis among 2152 breast lesions ,1339 cancers were diagnosed by CNB. The falsenegative rate of CNB was 3. 5% （51/1461）, and the underestimation rate was 4. 9% （71/1461）. In the repeat biopsy, carcinoma was found in 17 （50. 0% ） of 34 atypical ductal hyperplasia lesions and 25 （46.3%） of 54 papillary lesions. In 1461 cancers, the false-negative rate of ultrasound-guided CNB （2.1%, 22/1068） was significantly lower than that of free-hand-guided CNB （7.4%, 29/393） （P 〈0. 05）. The false-negative rate of two special doctors for CNB （1.2% ,8/681 ） was significantly lower than that of other doctors （5. 5% ,43/780） （P 〈0. 05）. In 738 of benign lesions,417 cases were excised and 50 malignant lesions were found,205 cases were followed up by 2-29 months （median, 10. 2 months）, and one malignant lesion was found. Conclusions Ultrasound-guided core needle biopsy with histopathological assessment is an accurate method in diagnosis of breast lesions. Excisional biopsy is required to the high-risk lesions in CNB.

关 键 词：乳腺肿瘤 活组织检查 针吸 病理学 外科 超声 乳腺 

分 类 号：R655.8[医药卫生—外科学]