磁共振成像引导下乳腺微小病变穿刺的临床应用初探  

Clinical application of MRI-guided puncture of breast microlesions

作　　者：王昕[1] 王文彦[1] 王杰[1] 宋颖[2] 王翔[1] 叶枫[2] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院乳腺外科,100021 [2]中国医学科学院北京协和医学院肿瘤医院乳腺外影像诊断科,100021

出　　处：《中华肿瘤杂志》2015年第9期682-685,共4页Chinese Journal of Oncology

摘　　要：目的探讨磁共振成像（MRI）引导下乳腺肿瘤穿刺定位及活检的临床适应证，评估其临床应用价值。方法收集30例MRI引导下穿刺定位或活检的乳腺微小病变患者的临床病理资料，分析MRI引导下穿刺定位或活检的情况及病理和随访结果。结果30例患者的微小病变全部准确穿刺成功，其中病理诊断为浸润性癌6例（20．0％），导管内癌9例（30．0％），良性病变15例（50．0％）。22例患者经超声和钼靶等影像学检查未能发现明确病灶，行MRI引导穿刺定位或活检后，病理报告为浸润性癌或导管内癌11例（50．0％）。MRI检查提示恶性或警惕恶性者21例，其中7例病理报告为良性病变，假阳性率为33.3％；MRI检查考虑良性者9例，其中1例病理报告为恶性，假阴性率为11．1％。全组患者均未出现血肿、感染等穿刺后并发症。全组患者的中位随访时间为7．5个月，1例患者因乳腺癌转移死亡，1例因影像学检查提示复发再次行手术治疗，1例失访，其余患者定期复查结果均未见异常。结论MRI引导乳腺微小病变穿刺是一种安全、快速、准确的诊断方法，在超声及钼靶不能发现明确病灶时，可采用MRI引导下穿刺定位或活检明确诊断，以提高乳腺癌早诊早治水平。Objective To explore the clinical indications of MRI-guided puncture positioning or biopsy, and evaluate the clinical practical value. Methods The clinicopathological data of 30 patients who underwent MRI-guided puncture positioning or biopsy were retrospectively collected and analyzed, and the patients were followed up after operation. Results The success rate of MRI-guided puncture was 100%. After biopsy or surgical resection, the pathological diagnoses were as follows： 6 cases （20.0%） of invasive carcinoma, 9 cases （30.0%） of ductal carcinoma in suit （DCIS） , and 15 cases （50.0%） of benign lesions, and the false negative rate was 0. In the 30 patients, the lesions of 22 patients were not clear and difficult to analyze qualitatively by ultrasound or mammography imaging examination. After MRI-guided puncture positioning or biopsy, the pathological examination showed that 11 cases （50.0%） of them were malignant tumors. MRI examinations indicated as malignant in 21 cases, among them, seven cases were pathologically confirmed as benign pathology, with a false positive rate of 33.3%. MRI examination considered benign in 9 cases, in which one case was pathologically diagnosed as malignant, thus, the false negative rate was 11.1%.In the 30 patients, there were no hematoma, infection and other complications after the puncture. The median follow-up time was 7.5 months. One patient died due to breast cancer metastasis, one patient showed relapse by imaging examination and underwent surgery, one case was lost, and the remaining patients were normal in the regularly follow-up results. Conclusions MRI-guided biopsy of breast microlesions is a safe, rapid and accurate diagnostic method. When the ultrasound and mammography can not find clear lesions or the lesions are difficult to analyze qualitatively, MRI-guided puncture positioning or biopsy can be applied to improve early diagnosis and treatment, and reduce false negative rate of breast cancer.

关 键 词：磁共振成像 乳腺微小病变 穿刺术 活检 诊断 

分 类 号：R737.9[医药卫生—肿瘤]