钼靶、超声、乳管镜下放置定位针在引导切除触诊阴性乳腺病变中的应用探讨  

Application of localization needles under mammographic, ultrasound or fiberoptic ductoscopy guidance for the nonpalpable breast lesions

作　　者：苑著[1] 屈翔[1] 王宇[1] 张忠涛[1] 

机构地区：[1]首都医科大学附属北京友谊医院普外科,北京100050

出　　处：《中国实用外科杂志》2016年第4期441-444,共4页Chinese Journal of Practical Surgery

基　　金：北京市科委"首都临床特色应用研究"专项(No.Z141107002514120)

摘　　要：目的探讨钼靶、超声、乳管镜三种不同方法放置定位针在引导切除触诊阴性乳腺病变(NPBL)中的应用。方法首都医科大学附属北京友谊医院于2013年6月至2014年12月间对83例临床NPBL病人进行手术,根据检出病灶的影像学方法及病灶特性的不同,术前分别采用钼靶、超声、乳管镜等不同方法放置定位针,引导切除病灶。回顾性分析病人的影像学检查、穿刺定位方法、手术情况、病理组织学及综合治疗情况。结果钼靶下穿刺定位并接受手术的乳腺钙化灶27例,术后证实27例钙化灶均准确切除,定位针均较好固定于病变附近,术后病理学检查证实恶性病变8例。超声下穿刺定位并接受手术的乳腺病变32例,病理学检查证实准确切除病灶30例,未见明确病灶2例,术后病理学检查证实恶性病变4例。乳管镜下放置定位针或联合亚甲蓝染色并接受手术的乳腺导管内占位性病变24例,术后病理学检查证实24例病人均准确切除病灶,除1例回形头脱落外,其余23例定位针均较好固定于病变乳管侧壁,术后病理学检查证实恶性病变5例。结论钼靶、超声及乳管镜放置定位针引导切除NPBL,提高了临床中手术切除NPBL的准确性,有助于NPBL的定性诊断,促进触诊阴性乳腺癌病灶的早发现与早诊断,提高了乳腺癌的诊断水平。Objective To evaluate the usefulness of localization needles under mammographic, uhrasound or fiberoptic ductoscopy guidance for nonpalpable breast lesions. Methods Eighty-three patients undergoing needle localization and biopsy of a nonpalpable breast lesions under mammographic ,ultrasound or fiberoptic ductoscopy guidance from June 2013 to December 2014 in Beijing Friendship Hospital were included in the study. The preoperative imaging assessment, application of localization needles, surgical operation and pathological examination were recorded and analyzed retrospectively. Results A total of 83 localization and biopsies were carried out, of which 27 were performed under mammographie guidance, 32 under ultrasound guidance and 24 under fiberoptic ductoscopy guidance. Twenty-seven cases of breast microcalcifications were localized under mam-~mographic guidance and surgically removed, of which 8 cases pathologically diagnosed as malignant.Thirty-two cases of nonpalpable breast lesions were localized under ultrasound guidance and 30 pathologically diagnosed, of 4 cases pathologically diagnosed as malignant.Twenty-four cases of intraduetal occupying lesions were localized under ductoscopy guidance and surgically removed, of 5 cases pathologically diagnosed as malignant. Conclusion It is a safe and effective procedure of localization needles under mammographic, ultrasound or fiberoptic ductoscopy guidance for nonpalpable breast lesions. With the help of this procedure, more malignant lesions are localized and surgically removed, and which is more helpful for the diagnosis of breast cancer.

关 键 词：乳腺 触诊阴性病变 钼靶 超声检查 乳管内视镜 

分 类 号：R6[医药卫生—外科学]