真空辅助旋切活检和金属丝定位活检对不能触及乳腺病灶的诊断价值  

Vacuum-assisted biopsy and wire localization for the diagnosis of non-palpable breast lesions

作　　者：苏昆仑[1] 徐海滨[1] 胡祖健[1] 何俊玲[1] 杨欧欧[1] 胡望华[1] 

机构地区：[1]浙江中医药大学附属广兴医院乳腺外科,杭州310007

出　　处：《中华肿瘤杂志》2010年第6期472-475,共4页Chinese Journal of Oncology

摘　　要：目的 评价真空辅助旋切活检和金属丝定位活检对不能触及的乳腺病灶（NPBL）诊断的准确性和有效性.方法 将97例NPBL患者随机分为两组,分别行金属丝定位切除活检（48例）和真空辅助旋切活检（49例）,活检标本均经钼靶确认.记录真空辅助活检组对不典型增生和导管原位癌的低估率以及切缘.对术后的乳房美容效果及术后第1天疼痛强度进行评分.结果 两组患者均成功活检,真空辅助旋切活检组的标本大小为2.3 cm3,显著小于金属丝定位切除活检组（18.4cm3,P=0.03）.真空辅助活检组对不典型增生和导管原位癌的低估率分别为16.7%和11.1%.真空辅助旋切活检组的诊断符合率为97.9%,假阴性率为2.1%,无假阳性病例.真空辅助旋切活检组手术后第1天疼痛评分为1.7,低于金属丝定位切除活检组（2.5,P=0.02）.真空辅助旋切活检组术后美容评分优良40例,良好8例;金属丝定位切除活检组优良25例,良好24例,两组差异有统计学意义（P〈0.05）.结论 真空辅助旋切活检结果 可靠,可使大部分良性病变患者免于开放手术,但由于组织学诊断的低估以及较高的切缘阳性率,真空辅助旋切活检尚不能完全替代金属丝定位活检.Objective To compare the effectiveness and accuracy of the use of vacuum-assisted biopsy （ VAB） versus wire localization （ WL） in the diagnosis of non-palpable breast lesions （ NPBL）. Methods Ninety-seven consecutive women with NPBL were randomized into VAB group and WL group.All specimens were identified by mammography. The patients were requested to score the cosmetic appearance of their breast after operation, and a numerical rating scale was used to measure pain on the first postoperative day. Underestimation rates for atypical ductal hyperplasia （ ADH） and ductal carcinoma in situ （ DCIS） were recorded if open surgical biopsy revealed DCIS and invasive cancer, respectively. Clear margins were also recorded in the two groups.Results VAB and WL located all the NPBL successfully. In the VAB group, the specimen volume was smaller than that of the WL group （2.3 cm3 vs. 18. 4 cm3, P = 0. 03）. Underestimation rates of ADH and DCIS in the VAB group were 16. 7% and 11. 1% , respectively. The diagnostic accordance rate of VAB was 97. 9% , the false negative rate was 2. 1% , and there was no false positive case. The means of the numerical rating pain scale were different in both groups （1.7 for VAB vs. 2.5 for WL, P =0. 02）.When cosmetic results were taken into account, 40 VAB patients had excellent outcomes and 8 good outcomes, compared with 23 excellent and 24 good for the WL group. There were better cosmetic outcomes with the VAB procedure （ P 〈 0.05）. Conclusion VAB is highly reliable and may avoid diagnostic open surgery in the majority of patients with benign lesions. However, because of the underestimation of histologic diagnosis and tumor margin involvement, VAB can not be used to completely substitute wire localization.

关 键 词：乳腺肿瘤 诊断 真空辅助旋切活检 金属丝定位活检 

分 类 号：R737.9[医药卫生—肿瘤]