超声引导下穿刺活检对乳腺病变诊断价值的研究进展  

Research progress of the value of ultrasound-guided needle biopsy in diagnosis of breast lesions

作　　者：张傲雪 贾红燕[2] ZHANG Ao-xue;JIA Hong-yan(The First Clinical School of Shanxi Medical University,Shanxi Province,Taiyuan030001,China;Department of Breast,the First Hospital of Shanxi Medical University,Shanxi Province,Taiyuan030001,China)

机构地区：[1]山西医科大学第一临床医学院,山西太原030001 [2]山西医科大学第一医院乳腺科,山西太原030001

出　　处：《中国当代医药》2021年第23期36-39,44,共5页China Modern Medicine

摘　　要：乳腺病变治疗决策的制定受病理结果影响,但穿刺病理低估的情况时有发生。为提高病变的检出率以及病理符合率,需评估那些容易被漏诊或低估的病变类型。本文通过分析近年来国内外超声引导下穿刺活检对不同乳腺病变类型的低估率、发生低估的可能原因及出现低估的高危因素得出结论:超声引导下穿刺活检对非肿块型及小体积乳腺病变的诊断可采用辅助手段提高检出率及评估准确性;对导管内乳头状病变及浸润性乳腺癌评估的准确性较高,但因肿瘤异质性及肿瘤中心坏死的存在需对浸润性乳腺癌多点取材,以提高免疫组化结论的符合率;对非典型增生、小叶原位癌、导管原位癌评估的准确性不理想,需要后续严密监测或采用手术治疗手段。对于可能恶性的乳腺病变,应在穿刺时使用穿刺鞘避免穿刺针道种植转移的发生,或在后续治疗中采取放射治疗手段降低种植转移概率。综上,超声引导空芯针穿刺活检是目前诊断乳腺病变的首选方法,核磁引导下穿刺活检和真空辅助下活检等可成为新的取材选择。The decision-making for the treatment of breast lesions is affected by the pathological results,but the underestimation of puncture pathology occurs frequently.In order to improve the detection rate of lesions and the pathological coincidence rate,it is necessary to evaluate types of lesions which are easily missed or underestimated.This paper analyzed the underestimation rates of different types of breast lesions by ultrasound-guided needle biopsy in recent years,possible causes of underestimation,and high-risk factors for underestimation.Auxiliary methods could be used to improve the detection rate and evaluation accuracy of ultrasound-guided needle biopsy in the diagnosis of non-mass and small-volume breast lesions.The evaluation accuracies of intraductal papillary lesions and invasive breast cancer were relatively high.However,due to the tumor heterogeneity and tumor center necrosis,it was necessary to conduct multi-point selection of cancer materials for invasive breast cancer to improve the coincidence rate of immunohistochemical conclusions.The evaluation accuracies of atypical hyperplasia,lobular carcinoma in situ,and ductal carcinoma in situ were not ideal,and follow-up close monitoring or surgical treatment was required.For breast lesions that might be malignant,a puncture sheath should be used during puncture to avoid the occurrence of puncture needle implant transfer,or radiotherapy should be used in subsequent treatment to reduce the chance of implant transfer.In summary,ultrasound-guided hollow-core needle biopsy is currently the preferred method for diagnosing breast lesions.Nuclear magnetic-guided needle biopsy and vacuum-assisted biopsy can become new choices for material selection.

关 键 词：超声引导穿刺活检 空芯针穿刺活检 乳腺病变 诊断价值 

分 类 号：R737[医药卫生—肿瘤]