乳腺微小病灶病理活检360°定位穿刺技术的设计与临床应用  

Design and Clinical Application of Breast Biopsy with 360° Positioning Puncture of Small Lesions

作　　者：梁建堂 王凤 潘忠清 梁爽 

机构地区：[1]山东省青州市人民医院放射科,山东青州262500

出　　处：《实用放射学杂志》2010年第5期719-723,共5页Journal of Practical Radiology

摘　　要：目的 探讨乳腺数字摄影导引下对乳腺微小病灶病理活检定位穿刺新技术与留置导丝引导手术切除活检的临床应用价值.方法 36例乳腺临床触诊阴性,而乳腺摄影显示的成簇细小钙化、白星状影、模糊小结节及局部结构紊乱等微小病灶,在乳腺数字影像上以乳头后线（PNL线）为基线,根据头尾位（CC位）与内外侧位（ML位）显示的坐标值,测算出病灶距离皮肤最近点位并确定穿刺的最佳角度和深度,实现360°的全方位定位穿刺.用该定位穿刺技术留置导丝于可疑病灶区,指引手术切取组织行病理学检查.结果 36例微小病灶位外上象限22例,内上象限8例,外下象限3例,内下象限3例.以误差≤5 mm为满意,穿刺满意率97.2%.病理结果：乳腺癌12例（33.3%）,重度不典型增生4例,中至重度不典型增生1例,轻度不典型增生3例,乳头状瘤样增生5例,纤维囊性乳腺病11例.结论 360°定位穿刺技术对早期发现乳腺癌进而提高患者生存率具有重要的临床价值.Objective To explore the clinical value of breast biopsy with positioning puncture for small lesions under digital mammography guided and positioning hook wire catheter to guide surgical resection biopsy. Methods 36 cases at clinical palpation of breast were negative, while mammography showed small calcification clusters, white astral--shaped shadows, fuzzy small nodules and structural disorder underwent breast biopsy with 360° positioning puncture. Before puncture,on mammographic images, the posterior nipple line（PNL line） regard as baseline, according to the coordinates of craniocaudal view（CC） and the medial lateral view （ML） digitally displayed, the nearest puncture points from the skin to lesions were measured,then to determine the best puncture angle and depth. By the positioning puncture technique,the catheter positioning hook wires in the area of suspicious lesions were set to guide surgery. Results The lesions in 36 cases localized at the laterosuperior quadrant in 22, mediosuperior quadrant in 8,1ateroinferir quadrant in 3 and medioinferior quadrant in 3. The puncture satisfactory rate was 97.2 %（error rate ≤5 mm）. Pathological results showed breast carcinoma in 12 cases, severe atypical hyperplasia in 4 cases, middle-to-severe atypical hyperplasia in 1, slight atypical hyperplasia in 3 cases,papilloma hyperplasia in 5 cases and fibrocystic breast disease in 11 cases. Conclusion 360° positioning biopsy has important clinical value in detection of early breast cancer and improving survival of patients.

关 键 词：乳腺 乳腺癌 乳腺数字摄影 定位穿刺 活检 

分 类 号：R737.9[医药卫生—肿瘤] R446.8[医药卫生—临床医学]