X线立体定位真空辅助活检对临床不可触及且超声检查阴性的钼靶乳腺微小钙化的应用价值  

Stereotactic Vaccum-assisted Breast Biopsy for Diagnosing Breast Microcalcifications Unpalpable and Unrecognisable by Ultrasonography

作　　者：石剑[1] 魏建南[1] 张文夏[1] 李欢[1] 林小颜[1] 

机构地区：[1]南方医科大学附属深圳妇幼保健院乳腺外科,深圳518000

出　　处：《中国微创外科杂志》2015年第8期684-686,698,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：深圳市科技计划项目(200703268)

摘　　要：目的探讨乳腺X线立体定位真空辅助活检（stereotactic vaccum-assisted breast biopsy,SVAB）对临床不可触及且超声检查阴性的钼靶乳腺微小钙化的应用价值。方法 2011年1月～2013年12月,对278例临床不可触及且超声检查阴性的钼靶乳腺微小钙化行SVAB,BI-RADSⅣ级261例,Ⅴ级17例。病理诊断为乳腺癌进一步手术治疗;轻、中度乳腺导管上皮不典型增生（atypical ductal hyperplasia,ADH）病例采取影像学随访1年以上,重度ADH则进一步手术活检;除ADH外的良性病变结束治疗。结果 SVAB活检成功率为99.3%（276/278）。病理诊断乳腺癌27例（9.7%）,包括导管内癌22例,导管内癌微浸润3例,浸润性导管癌2例,22例导管内癌组织学低估率为18.2%（4/22）;乳腺ADH 27例（9.7%）,其中轻度ADH 18例,中度ADH 4例,重度ADH 5例,未发现组织学低估;除ADH外的良性病变224例（80.6%）,包括纤维囊性乳腺病129例,硬化性腺病85例,乳头状瘤10例。BI-RADSⅣ级恶性率5.0%（13/261）,Ⅴ级恶性率82.4%（14/17）。结论临床不可触及且超声检查阴性的钼靶下乳腺微小钙化行SVAB可明确诊断乳腺癌和ADH,对ADH未见组织学低估,且不需要全部进一步手术切检,有较高的临床应用价值。Objective To evaluate the diagnostic value of stereotactic vaccum-assisted breast biopsy （SVAB） for breast microcalcifications which can not be found by physical examination and ultrasound. Methods Between January 2011 and December 2013, SVAB with 10-gauge vacuum devices was performed in 278 patients with non-palpable microcalcification lesions detected by mammography, including 261 cases of BI-RADS grade Ⅳ and 17 cases of grade Ⅴ . Patients with mild-intermediate degree of atypical ductal hyperplasia （ADH） were followed-up by imaging for more than one year. Severe degree ADH and breast cancer cases were performed by opening surgery. The other benign diseases cases were completed of therapy. Results The biopsy successful rate was 99.3% （276/278）. There were 9.7% （27/278） of total biopsy diagnosed as having breast cancer, including 22 cases of ductal carcinoma in situ （DCIS） , 3 cases of DCIS with microinvasion, and 2 cases of invasive ductal carcinoma. The histopathological underestimation rate of DCIS to invasive carcinoma was 18.2% （4/22）. ADH cases were found in 9.7% of total biopsy numbers, including 18 cases of mild ADH, 4 cases of intermediate degree, and 5 cases of severe degree ADH. The histopathological underestimation rate of ADH to carcinoma was zero. In addition to the ADH benign lesions, there were 129 cases of cystic breast disease, 85 cases of sclerosing adenosis, and 10 cases of intraductal papilloma. The malignant rates were 5.0% （ 13/261 ） in BI- RADS grade Ⅳ cases and 82.4% （14/17） in grade Ⅴ cases. Conclusion The breast microcalcifications which can not be found by physical examination and ultrasound can be diagnosed by SVAB, with a low histopathological underestimation rate and advatages of not necessary for surgical excision in all the patients.

关 键 词：X线立体定位真空辅助活检术 乳腺导管不典型增生 组织学低估 

分 类 号：R737.9[医药卫生—肿瘤]