乳腺X线立体定位活检的临床应用及适应证选择  

Clinical application and indications of X-ray stereotactic biopsy under X-ray guidance for non-palpable breast lesions

作　　者：冀焕梅 梁秀芬 闫斌 戴强 李宏娟 刘瑾 袁勇 宋张骏 汪存涛 

机构地区：[1]陕西省肿瘤医院放射科 [2]陕西省肿瘤医院病理科 [3]陕西省肿瘤医院乳腺科,陕西西安710061

出　　处：《实用放射学杂志》2013年第5期764-767,共4页Journal of Practical Radiology

基　　金：陕西省卫生厅科研基金资助项目（2010D11）.

摘　　要：目的探讨X线引导下乳腺立体定位活检的临床应用及适应证。方法回顾分析173例临床不可触摸的乳腺病变（non-palpable breast lesion, NPBL）的临床及影像资料。23例行核芯针穿刺活检 （stereotactie core needle biopsy, SCNB），其中16例活栓后行外科手术，7例随访；150例（156个病灶）行X线立体定位导丝切检（stereotactic needle localized biopsy, SNLB）1次定位成功并完整切除。根据美国放射学会乳腺影像报告与数据系统（BI-RADs）对全组病例进行分类；对经手术病理确诊的166例172个病灶BI-RADS类别与病理良恶性进行统计学分析。结果本组病例均为BI-RADS3-5类，术后病理乳腺癌49个，非典型增生8个，良性病变115个，BI-RADS3、4、5类恶性率依次为：1．3％（1／73）、42％（37／88）、100％（11／11）；3、4、5类病灶恶性率间存在差异（P〈0．05），4B与4C类恶性率无统计学差异（P〉0．05），但均显著高于4A类（P〈0．05）。结论对BI-RADS4类以上病变进行定位活检，对部分BL-RADS3类及4A类病变拟采用SCNB活检，对于BL-RADS4B、4C类及5类拟行SNBI。活检。Objective To explore the clinical application and indications of stereotactic biopsy under X-ray guidance for non-palpa- ble breast lesions（NPBL）. Methods Clinical and imaging data of 173 patients with NPBL were retrospectively analyzed. In 173 ca- ses, 23 patients underwent stereotactie core needle biopsy （SCNB）,after that, 16 patients received surgical resection and 7 patients were followed clinically. In addition, 150 patients underwent X-ray guided stereotaetie needle localized biopsy（SNLB）. A total num- ber of 156 breast lesions in 150 patients were completely resected. 172 lesions resected in 166 patients were evaluated according to the breast imaging reporting and data system （BI-RADS） of American College of Radiology. Imaging diagnosis and pathological re- sults were compared, and the statistical correlation between the BI-RADS category and pathological results was analysed. Results 49 lesions were breast cancer, 8 lesions were atypical hyperplasia and 115 lesions were benign lesions. The malignant rates of BI-RADS category5 was higher （100%, 11/11）, followed byBI-RADS 4（42%, 37/88） and 3 （1.3%, 1/73）, respectively. Moreover, the malignant rate of patients defined as BI-RADS 4B and 4C was of no statistically significant difference （ P〉0.05）, but both of the a- bove-mentioned were higher than that in BIRADS 4A（P〈0.05 ）. Conclusion X-ray- guided breast biopsy is an important and crucial approach for patients with NPBL categorized above BI-RADS 4. SNI.B should be performed in patients with breast lesions defined as BI-RADS 4B, 4C and 5. In case of BI-RADS 3 and 4A, SCNB may be considered as a right choice.

关 键 词：乳腺 X线立体定位 乳腺X线摄影 活检 

分 类 号：R655.8[医药卫生—外科学] R446.8[医药卫生—临床医学]