MRI引导下乳腺病变真空辅助旋切活检术的临床应用  

Clinical application of MRI-guided vacuum-assisted biopsy for breast lesions

作　　者：党艳莉 聂品 刘儒玫 贾田菊 屈明珠 向芝莹 朱开国 胡锦涛 喻国艳 王苹苹 陈宝莹 DANG Yanli;NIE Pin;LIU Rumei;JIA Tianju;QU Mingzhu;XIANG Zhiying;ZHU Kaiguo;HU Jintao;YU Guoyan;WANG Pingping;CHEN Baoying(Imaging Diagnosis and Treatment Center,Xi'an International Medical Center Hospital,Xi'an 710700,China)

机构地区：[1]西安国际医学中心医院影像诊疗科,西安710700

出　　处：《磁共振成像》2024年第1期163-167,共5页Chinese Journal of Magnetic Resonance Imaging

基　　金：西安市菁英人才项目(编号:XAYC210045);西安市卫生健康委员会项目(编号:2023ms20);西安市科技计划项目(编号:22YXYJ0127);西安国际医学中心医院院级课题(编号:2022ZD03、2022QN22)。

摘　　要：目的 探讨MRI引导下真空辅助旋切活检术(vacuum-assisted biopsy, VAB)对仅MRI显示乳腺病变的可行性及诊断准确性。材料与方法 回顾性分析2019年9月至2022年12月在我院行MRI引导下VAB的患者27例,共27个病变。所有病灶BI-RADS分为4类或5类。采用3.0 T MRI扫描仪、开放式乳腺穿刺线圈、磁共振兼容活检穿刺定位架及MRI兼容耗材。记录病变的影像学特征、活检病理结果、恶性病变术后最终病理结果及术中、术后并发症情况。以手术后病理结果或良性病变至少半年后随访结果为金标准,计算VAB的诊断准确度、敏感度、特异度、阳性预测值及阴性预测值,并评估活检病变组织学低估情况。结果 所有病例均一次性成功取样并取得病理学结果,活检技术成功率100%(27/27)。平均操作时间(39.92±8.34)min。活检诊断为恶性病变7个(25.93%);非典型导管增生2个(7.41%);其余良性病变18个(66.67%),恶性病变检出率25.93%。将活检病理结果与术前MRI图像进行对照,未出现影像—病理不一致情况。所有活检诊断为恶性病变或非典型导管增生的患者进一步行外科手术切除,活检结果与术后病理结果相一致,未出现组织学低估情况;活检诊断为良性病变者,其中2个乳腺炎性病变半年随访病变缩小;其余随访未见明显变化。VAB结果显示准确度100%(27/27),敏感度100%(7/7),特异度100%(20/20),阳性预测值100%(7/7),阴性预测值100%(20/20)。1例患者在术中出现迷走神经反应症状,主要由精神紧张引起,经休息、心理安抚后很快恢复。结论 对于仅在乳腺MRI检查发现的可疑病变,MRI引导VAB能够安全、精准、有效地完成组织取样以用于病理学评估,病理诊断准确性高且并发症少,值得临床应用推广。Objective:To explore the feasibility and the diagnostic accuracy of MRI-guided vacuum-assisted biopsy(VAB)in lesions visualized by MRI only.Materials and Methods:Retrospective analyzed 27 patients with 27 lesions who underwent MR-guided VAB between September 2019 and December 2022.All of the breast lesions were categorized as 4 or 5 BI-RADS.All biopsies were performed on a 3.0 T system with a dedicated eight-channel open breast coil,an MRI compatible biopsy positioning frame and consumables.We recorded the lesion's imaging characteristics,the pathological outcomes of the biopsy and the final pathological results of the malignant lesions,as well as intraoperative and postoperative complications.The pathological results after surgery or the follow-up results of benign lesions at least six months later were used as the gold standard,the diagnostic accuracy,sensitivity,specificity,positive predictive value and negative predictive value of VAB were calculated,as well as the histological underestimation of biopsied lesions.Results:Technical success was achieved in all biopsies.The average operation time was(39.92±8.34)min.After biopsy,7 of 27 lesions(25.93%)were malignant,2 of 27 lesions(7.41%)were atypical ductal hyperplasia,and 18 of 27 lesions(66.67%)were remaining benign.When the pathological results were compared with preoperative MRI images,no radiology-pathology inconsistency were discovered.All patients who were diagnosed with malignant tumors or atypical ductal hyperplasia underwent additional surgical resection.Without any histological underestimate,the biopsy results were consistent with the postoperative pathological outcomes.The lesions of two mammary inflammatory lesions diminished in half a year follow-up in all patients who were diagnosed with benign lesions by biopsy,and no significant changes were seen in the rest.The results of VAB showed 100%(27/27)accuracy,100%(7/7)sensitivity,100%(20/20)specificity,100%(7/7)positive predictive and 100%(20/20)negative predictive value.One patient experienced vagal

关 键 词：乳腺疾病 病理诊断 影像—病理一致性 磁共振引导 活组织检查 真空辅助 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]