超声引导下乳腺微创旋切术在筛查触诊阴性早期乳腺癌中的应用  

Application of Ultrasound Guided Minimally Invasive Rotatory Excision for the Screening of Non-palpable Early Breast Cancer

作　　者：张勤[1] 常万利[2] 王遵义[1] Zhang Qin;Chang Wanli;Wang Zunyi(Department of Thyroid and BreastⅢ,Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]河北省沧州市中心医院甲乳外三科,沧州061000 [2]辽宁省绥中县医院普外科,绥中125200

出　　处：《中国微创外科杂志》2022年第8期627-632,共6页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨超声引导下乳腺微创旋切术作为一种活检方式在筛查早期乳腺癌中的价值。方法 2016年6月~2019年6月我院对568例(1071个结节)临床触诊阴性,且直径<10 mm的乳腺结节行乳腺微创旋切术,超声探头引导下纵向进针,横向旋切,将切除的标本立即行冰冻切片病理检查,根据病理结果制定进一步手术方案。结果 每个结节旋切时间(3.1±1.3)min。555例(97.7%)共1058个结节为良性病变,其中腺纤维瘤672个,乳腺腺病伴腺瘤形成趋势(含乳腺腺病) 371个,导管内乳头状瘤6个,其他良性疾病(乳腺炎、上皮增生活跃伴或不伴不典型增生等) 9个。重度不典型增生2例(0.4%),再次进行局部扩大切除术。恶性病变11例(1.9%),其中浸润性导管癌8例,导管原位癌3例。BI-RADS 3类426例中4例乳腺癌,恶性率0.9%(4/426);4a类142例中7例乳腺癌,恶性率4.9%(7/142)。结论 超声引导下乳腺微创旋切术定位精准、创伤性小、安全可靠,在触诊阴性的乳腺小结节(≤10 mm)中作为一种活检方式筛查早期乳腺癌具有独特的优势,尤其适合乳腺BI-RADS 3、4a类合并乳腺癌发病高危因素,不宜定期观察的患者。Objective To explore the application value of ultrasound guided minimally invasive rotatory excision as a biopsy method for screening of early breast cancer. Methods Clinical and pathological data of 1071 lesions from 568 patients who underwent minimally invasive breast resection in our hospital from June 2016 to June 2019 were selected. All the patients had negative clinical palpation and a tumor diameter less than 10 mm. A needle was inserted longitudinally under the guidance of the ultrasound probe, and rotatory excision was performed laterally. The excised specimens were immediately subjected to frozen section pathological examination, and further surgical plans were made based on the pathological results. Results The time of rotatory excision for each tumor lesion was(3.1±1.3) min. A total of 1058 lesions from 555(97.7%) patients were benign masses, including 672 fibroadenomas, 371 breast adenopathy with adenoma formation(including breast adenopathy), 6 intraductal papillomas, and 9 other benign diseases(mastitis and active epithelial hyperplasia with or without dysplasia). Two patients(0.4%) were found adenofibroma with severe atypical hyperplasia, and received extended local excision. Eleven patients(1.9%) had malignant lesions, including 8 cases(1.4%) of invasive ductal carcinoma and 3 cases(0.5%) of ductal carcinoma in situ. Among the 426 patients with BI-RADS grade 3, there were 4 cases of breast cancer, with a malignant rate of 0.9%(4/426). A total of 7 out of 142 patients with BI-RADS grade 4 a had breast cancer, with a malignant rate of 4.9%(7/142). Conclusions Ultrasound guided minimally invasive rotatory excision is accurate, minimally invasive, safe and reliable. It has unique advantages for screening of early breast cancer in small breast nodules(≤10 mm) with negative palpation, especially suitable for BI-RADS grade 3 and 4 a patients with high-risk factors for breast cancer, which is not suitable for regular observation.

关 键 词：超声引导 乳腺癌 乳腺微创旋切术 

分 类 号：R737.9[医药卫生—肿瘤] R445.1[医药卫生—临床医学]