MRI引导定位活检术对仅MRI显示乳腺病变的应用  

The Application of MRI Guided Breast Localization and Biopsy in Breast Lesions Visualized by MRI Only

作　　者：赵玉年[1] 唐金海[2] 沈文荣[1] 郭震[1] 秦建伟[2] 李健[2] 董珉[1] 杨波[1] 王慧华[1] 刘念龙[1] 

机构地区：[1]江苏省肿瘤医院放射科,南京210009 [2]江苏省肿瘤医院乳腺外科,南京210009

出　　处：《临床放射学杂志》2015年第6期889-894,共6页Journal of Clinical Radiology

基　　金：国家863计划项目(编号:2014AA020604)

摘　　要：目的评估MRI引导下定位活检对仅MRI显示乳腺病变的应用价值。方法搜集52例56个MRI上显示而其他影像技术难以显示的隐匿病灶。全部病灶BI-RADS分类4级或4级以上。采用1.5 T超导MRI仪,乳腺MRI专用定位活检穿刺架及乳腺MRI专用定位针和定位导丝。根据MRI检查发现可疑病灶的部位选择外侧位、内侧位或轴位行定位活检。观察操作方式及定位准确性。结果 52例56个病灶均一次定位成功,病理切片证实病变完全切除,成功率达100%。病理结果:52例56个病灶中乳腺导管内癌8个,浸润型癌7个,乳腺导管内乳头状瘤病1个,乳腺导管上皮不典型增生7个,乳腺腺病伴高度增生20个,乳腺纤维腺瘤13个。术前MRI诊断与术后病理结果对照MRI诊断符合率89.29%(50/56)。结论对仅MRI显示的乳腺隐匿病灶,MRI导引的定位活检是一种安全可靠的方法,弥补了其他影像方法的不足及假阴性的发生,是对钼靶和超声引导乳腺定位活检的重要补充,为微创手术治疗提供了又一种精确导向的方式。Objective To explore the application value of MRI guided breast localization and biopsy in lesions visualized by MRI only. Methods 56 non palpable breast lesions in 52 patients were observed by MRI but not visualized by mammography or ultrasound,All of the breast lesions were categorized as 4 to 5 on BI-RADS. Hook wire localization and Biopsies were performed using a 1. 5 T MR with a seven channel breast coil in a clock face configuration with a 20 gauge vacuumassisted biopsy device. According to the MRI results,positioning biopsy was performed in the lateral and medial position or axial line of the breast lesions. The feasibility of operation and accuracy of localization were explored. Results The location and surgical excision were succeeded on the 52 patients.（ 100%）. The pathologic findings were as followed：ductal carcinoma in situ（ DCIS） in 8 rest lesions,invasive cancer in 7 rest lesions,intraductal papilloma in 1 rest lesions,atypical ductal hyperplasia（ ADH） in 7 rest lesions,breast adenosis in 20 rest lesions,fibroadenomas in 13 rest lesions. The diagnostic sensitivity of biopsy was 89. 29%（ 50 /56）. Conclusion MRI guided breast lesion localization and biopsy provides an accurate and safe method for detecting the occult breast lesions and helps to perform minimally invasive surgery. Also,it is an alternative method for ultrasound and mammographic occult lesions and made up the deficiency of other imaging methods.

关 键 词：乳腺肿瘤 磁共振成像 定位术 放射外科手术 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]