EnCor真空辅助旋切系统在多发性乳腺肿物微创切除术中的应用

目的探讨超声引导下EnCor真空辅助旋切系统治疗乳腺多发性肿物（单侧乳腺肿物≥3个）的价值。方法2009年3月～2010年1月,对700例多发性乳腺肿物在超声引导下进行EnCor切除术（美国SenoRx公司EnCor旋切系统）,术中旋切刀刀槽位于肿物下方或侧方进行扇形或大角度旋切,切除组织收纳于标本收集盒中送冰冻病理检查。结果全部乳腺肿物均采用EnCor旋切,均使用1把旋切活检针成功完成单侧乳腺肿物切除。术后病理：纤维腺瘤319例,纤维囊性乳腺病241例,瘤样增生96例,导管内乳头状瘤44例。术后并发症：皮下瘀斑24例,血肿形成11例,乳头溢血1例。679例随访3～12个月,平均6个月,均未发现病灶残留、复发,且无切口瘢痕形成,乳房外形正常,皮肤触觉无异常。结论超声引导下EnCor旋切术可完整切除乳腺多发性病灶,具有微创、美容、操作简单、安全等优点。     

早期乳腺癌Mammotome活检术后原发灶切缘状况研究

目的探讨早期乳腺癌mammotome微创切除活检后切缘癌残留状况。方法在高频超声引导下对2 8 3例临床不可触及的乳腺病灶施行mammotome微创切除活检术;对其中病理确诊为乳腺癌的5 2例施行保乳手术,术中对原发病灶切缘进行病理检查。结果 5 2例乳腺癌患者中,3 8例为乳腺导管内癌,1 4例浸润性导管癌;mammotome活检术后,4 3例原发灶切缘阴性,9例阳性。9例切缘阳性再行局部切除后5例切缘阴性,余4例切缘阳性改行乳房单纯切除。该4例术后病理为广泛性导管内癌(extensive intraductual component,EIC)。4 8例mammotome活检与术后病理一致。结论高频超声引导下mammotome微创活检诊断早期乳腺癌安全、可靠,对于局限的临床不可触及的乳腺癌病灶,可以收到病灶切除的效果。     

超声引导下负压吸引旋切术治疗乳腺肿瘤

目的探讨超声引导下负压吸引旋切术治疗乳腺肿瘤的治疗效果。方法回顾性分析2010年9月-2011年4月在我院接受超声引导下乳腺肿瘤旋切术的26例患者（38个病灶）的临床资料及术后病理检查与随访情况。结果采用EnCor真空辅助旋切系统全部切除38个病灶,术后肿瘤无残留、复发,无明显血肿、感染,穿刺点无明显瘢痕。结论超声引导下乳腺旋切术是诊断和治疗乳腺肿瘤、特别是不易触及的乳腺小病灶的有效方法。     

乳腺X线三维立体定位真空辅助乳腺活检在乳腺X线可疑钙化诊断中的价值北大核心CSCD

目的探讨乳腺X线三维立体定位真空辅助乳腺活检在可疑钙化中的应用价值。方法2016年1月~2018年12月对242例临床不可触及且超声检查阴性,乳腺X线可疑钙化,在乳腺X线三维立体定位下采用EnCor真空辅助乳腺活检系统旋切取活检,利用乳腺X线0°导航位和±15°立体定向确定病灶位置后,从该位置插入旋切刀进行微创旋切取活检。结果242例顺利完成活检,活检病理诊断良性病变205例(非典型病变16例),恶性病变37例(导管原位癌30例,浸润性导管癌7例)。37例恶性病变手术治疗,7例为浸润性导管癌,其中5例钙化完全切除,手术时无肿瘤残留,2例有残余微钙化和残余肿瘤;30例为导管原位癌(ductal carcinoma in situ,DCIS),其中28例钙化病灶完全切除,2例活检术中有肿瘤残留[手术切除标本示导管内癌伴早期浸润,DCIS升级率为6.7%(2/30)]。11例非典型性病变手术治疗,10例术后病理诊断为腺病,1例升级为DCIS,非典型增生升级率9.0%(1/11);5例非典型病变在3年的随访中无可疑发现。结论乳腺X线立体定位下真空辅助乳腺活检可以较好地应用于可疑钙化的微创活检,值得推广。     

超声引导下真空辅助微创旋切术和定位导丝活检术对不可触及乳腺病变定性诊断的比较

目的 比较超声引导下真空辅助微创旋切术和定位导丝活检术对不可触及乳腺病变定性诊断的准确率.方法 对30例30处不可触及乳腺病变行超声引导下真空辅助微创旋切术,19例20处行超声引导下定位导丝活检术.结果 真空辅助微创旋切术检出的30例不可触及乳腺病变中,4例为浸润性乳腺癌（13.3％）,3例不典型增生;定位导丝活检术检出的19例20处不可触及乳腺病变中,2例为浸润性乳腺癌（10％）,1例为原位癌（5％）;随访无复发.结论 超声引导下真空辅助微创旋切术是不可触及乳腺病变诊断的首选方法.     

高频超声引导下Mammotome旋切系统在乳腺微小钙化灶切取活检中的价值

目的探讨高频超声引导下Mammotome微创旋切系统在乳腺微小钙化灶切取活检中的临床价值。方法在高频超声引导下应用Mammotome系统对24例乳腺微小钙化灶施行微创旋切术，钙化灶切除后病理检查。结果24例病灶均被准确定位切取。24例乳腺钙化灶病理：乳腺癌3例（12．5％），其中导管原位癌2例，浸润性导管癌1例；乳腺良性病变21例（87．5％），其中囊性小叶增生9例，乳腺导管增生及扩张6例，硬化乳腺病5例，导管内乳头状瘤1例。结论高频超声引导下Mammotome微创旋切系统诊断乳腺疾病安全可靠，微创，是诊断乳腺疾病的有效方法。     

Mammotome旋切系统对乳腺不可触及的微小病灶的临床应用研究

目的探讨Mammotome旋切系统对临床不可触及的乳腺微小病灶进行组织活检的应用价值。方法在超声引导下应用Mammotome旋切系统对临床不可触及的乳腺微小67例进行组织活检,术后应用钼靶X线摄片检查防止活检遗漏,并行病理切片检查。结果67例病例,77处病灶。平均每处病灶旋切9～17条标本不等,共842条。术后病理结果示:乳腺导管内癌1例,浸润性导管癌2例,复合性浸润癌1例,均发生于Ⅳ级伴钙化或伴结构紊乱病例;腺病21例,囊性增生22例,不典型增生3例,囊肿3例、囊肿伴钙化2例,乳头状瘤病5例,乳腺纤维瘤7例。术后并发局部血肿2例。操作全部成功,无病变组织遗漏和严重并发症发生。结论超声引导下应用Mammotome旋切系统对不可触及乳腺内微小病灶进行穿刺活检,能够明确病灶组织病理学性质,对术后进一步治疗有指导意义。手术简便、创伤小、定位准确,是目前乳腺外科的发展方向之一。     

EnCor真空旋切加双套管负压引流治疗乳腺脓肿

目的探讨高频超声引导下EnCor真空旋切加双套管负压引流治疗乳腺脓肿的可行性及其临床应用价值。方法回顾性分析2012年10月至2015年10月期间于南京医科大学附属淮安第一医院治疗的41例乳腺脓肿患者的临床病理资料,其中有20例行EnCor真空旋切加双套管负压引流术(En Cor组),21例行常规切开引流术(对照组),比较2组患者疗效的差异。结果 2组患者在年龄、脓肿直径、脓肿位置等一般资料比较差异无统计学意义(P0.05)。2组患者手术治疗顺利,但EnCor组中有2例在旋切过程中发生出血,局部加压1 h后成功完成真空旋切术。2组的手术时间比较差异无统计学意义(P0.05)。EnCor组的切口瘢痕大小、治愈时间、住院时间、换药次数及疼痛评分均明显优于对照组(P0.05)。所有患者术后均治愈出院,无一例再手术,无术后出血、皮肤损伤、乳糜漏等并发症发生。41例患者术后随访3~20个月,平均12个月,无一例失访。查体结合高频超声检查无脓腔残留及复发征象。对照组切口疤痕较明显,有1例发生乳房变形;而EnCor组切口瘢痕微小,患者对术后乳房外形及治疗效果均满意。结论本研究的初步结果提示,EnCor真空旋切辅以双套管负压引流治疗乳腺脓肿安全、可靠、痛苦小且微创。     

超声引导下Vacora旋切术在乳腺多发良性疾病中的应用

目的探讨超声引导下真空辅助旋切系统(Vacora旋切系统)在乳腺多发(一侧乳腺病灶≥3个)良性病灶治疗中的应用价值。方法 2009年2月~2010年6月应用真空辅助旋切系统(美国巴德公司Vacora系统)对17例经B超检查发现直径≤3 cm的79个良性乳房肿瘤进行实时超声引导旋切,术后2 d,2个月及6个月对患者行超声随访,并将手术区超声图像与术前病灶图像进行对比分析,观察有无血肿,肿瘤残留及美容效果。结果所有乳腺多发病灶均准确并完整切除,经病理诊断均为良性。17例随访1~16个月,平均7.6月,1例术后14 d复查可见血肿形成,术后2个月血肿完全消失;1例术后3个月复查发现残留,继续跟踪随访;所有患者皮肤切口愈合良好,无明显切口瘢痕。结论超声引导下Vacora旋切系统对乳腺多发良性病灶切除效果好,具有美观、微创、安全、并发症少等优点。     

超声引导微创旋切术治疗乳腺肿块220例报道

目的探讨超声引导下微创旋切系统在乳腺肿块诊断和治疗中的价值。方法对我院2006年10月～2010年3月经超声引导Mammotome微创旋切术治疗的乳腺肿块220例疗效进行回顾性分析。临床可触及肿块137例,不可触及而超声检查出肿块83例。220例中有病灶共287个,单发病灶153例,多发(2～5个)病灶67例,肿块0.1～2.8cm。结果所有乳腺病灶被准确完全切除。切除组织标本均行病理检查,乳腺纤维腺瘤225个,乳腺腺病22个,乳腺腺病伴纤维腺瘤形成17个,乳腺囊肿11个,导管内乳头状瘤8个,早期乳腺癌4个(4例,经再次手术局部切除、保乳,无针道种植)。局部血肿2例,经局部引流治愈。全组随访3～36个月,平均17个月,1例术后3个月局部复发(可能为残余肿瘤组织生长),再次微创旋切。结论超声引导微创旋切术治疗乳腺肿块是一项创伤小、并发症少、安全有效的微创技术,对良性肿瘤能够完全切除;对恶性肿瘤提供足够的病理组织。     

Percutaneous excisional biopsy of impalpable breast lesions under ultrasound visualization

Within the last ten years, the development of innovative minimally invasive breast biopsy technologies has made a significant impact on the diagnostic evaluation of impalpable breast lesions. The Mammotome minimally invasive biopsy system is a diagnostic tool used under stereotactic or ultrasound guidance. The minimally invasive biopsies for 143 impalpable breast lesions in 86 patients were performed using the B-ultrasound-guided 8-gauge vacuum-assisted Mammotome system at Jinan Military General Hospital. One hundred and forty-three breast lesions in 86 patients were excised completely using this method. The average biopsy procedure time was 17 min (range, 3–45 min). Clinically, suspicious lesions were satisfactorily confirmed by this system. One hundred and twenty-one lesions were diagnosed as fibroadenoma, nineteen lesions as breast adenosis, one lesion as invasive breast cancer, and two lesions as ductal carcinoma in situ. Skin ecchymosis was found in two patients. One hundred and thirty-two impalpable lesions were completely excised, as demonstrated by the follow-up ultrasound examination. The results suggest that the B-ultrasound-guided Mammotome system may be an efficient tool for the diagnosis and treatment of impalpable breast lesions.     

An evaluation of a 10-gauge vacuum-assisted system for ultrasound-guided excision of clinically benign breast lesions

The aim of this study was to evaluate a 10-gauge vacuum-assisted system for the excision of clinically benign breast lesions.The minimal excision of 245 lesions in 162 patients was performed with VACORA vacuum-assisted system under the guidance of ultrasound between July 2007 and April 2008. The lesions were category 3 lesions as determined by ultrasound imaging according to Breast Imaging Reporting and Data System (BI-RADS) (n = 208) or had been confirmed as benign by a previous core-needle biopsy (n = 37).As many as 244 lesions were demonstrated to be benign and one case was demonstrated to be malignant by pathology after resection. In the 244 benign lesions, 220 lesions were excised completely as demonstrated by the follow-up ultrasound examination. The malignant lesion was managed with surgical excision.The 10-gauge vacuum-assisted system is highly successful for the excision of benign breast lesions; it is an alternative tool for minimal treatment of benign breast lesions.     

Percutaneous excisional breast biopsy

BACKGROUND: The utility of the vacuum-assisted breast biopsy device (VABB) under stereotactic guidance is well established. We hypothesized that the complete removal of small benign lesions under ultrasonography guidance in an outpatient setting could be obtained with minimal morbidity with the multidirectional hand held vacuum-assisted biopsy. METHODS: Patients enrolled in this study underwent an ultrasound-guided minimally invasive excisional breast biopsy through a 3-mm incision. Removal of the abnormality was accomplished with a handheld 8- or 11-gauge Mammotome. RESULTS: Eighty-one patients had 101 lesions excised. The average (+/- SD) age of the participants was 46.8 +/- 15.4 years. The average size of the lesions was 1.15 +/- 0.43 cm (range 0.5 cm to 2.0 cm). Ninety-four lesions (93%) had benign pathology, five lesions (5%) were malignant, and two (2%) lesions had atypical hyperplasia. Six-month baseline mammogram performed in 71% of patients more than 40 years old documented resolution of percutaneously removed lesions. CONCLUSIONS: Vacuum-assisted excisional breast biopsy under ultrasound guidance is an effective technique for the therapeutic management of benign lesions.     

数字化乳腺X线立体定位真空辅助活检53例

目的:探讨数字化乳腺X线立体定位真空辅助活检(stereotactic vacuum assisted breast biopsy,SVAB)在乳腺微小病变中的临床应用价值。方法:采用全数字化乳腺X线机、三维立体定位系统以及真空负压旋切活检系统,对53例临床不可触及的可疑乳腺微小病变(BI-RADS分级为Ⅳ级及以上)行SVAB。结果:SVAB诊断的特异性为100%,敏感性为96%;阳性预测值为100%,阴性预测值为95%;假阴性率为1.9%,无假阳性病例。结论:SVAB具有定位准确,操作安全、简便,手术成功率高,损伤小等特点,是临床诊断不可触及的乳腺微小病变的理想活检方法。     

Experience of stereotactic breast biopsy using the vacuum-assisted core needle biopsy device and the advanced breast biopsy instrumentation system in Hong Kong women

BACKGROUND: Stereotactic breast biopsy of non-palpable lesions using the vacuum-assisted core needle biopsy (CNB) device and the large core excision biopsy system is a reliable biopsy method when compared with open biopsy. Its use in Western countries is well accepted. This study aimed to assess the feasibility and results of using these systems to perform stereotactic biopsy in Asian women. METHODS: A total of 114 patients with non-palpable mammographic lesions underwent stereotactic breast biopsy using the vacuum-assisted CNB device and the large core excision biopsy system between November 1999 and December 2002. The indications for biopsy were mammographic abnormalities considered indeterminate or suspicious that were not palpable or visible on ultrasound. The methods adopted for biopsy in Asian women were reviewed and the results including the final pathology, complications, scarring and acceptance by patients were recorded. RESULTS: Stereotactic breast biopsy was performed using the vacuum-assisted CNB device in 107 patients and the large core excision biopsy system in seven patients. Of those who underwent biopsy using the vacuum-assisted CNB device, 15 (14%) had moderate to severe bleeding during the procedure and seven (6.5%) had severe bruising afterwards. Carcinoma was detected in 31 of the 114 patients (27.2%). CONCLUSION: Although Asian women in general have smaller and denser breasts than their Western counterparts, stereotactic breast biopsy using the vacuum-assisted CNB device and the large core excision biopsy system was feasible with modification of the individual steps during the procedure. Our results are comparable with those published previously and the procedure was well accepted by patients.     

乳腺微创真空旋切系统（EnCor）对乳腺肿物的诊治价值及切口的选择

目的：探讨超声下乳腺真空旋切系统（EnCor）进行乳腺病灶切除活检的切口选择。方法采用7G旋切探针进行操作,直径5 mm。良性可能性大的病灶,应尽量考虑美容效果好的腋下皮纹线、腋中线及乳晕切口;恶性可能性大的病灶应尽可能选择病灶附近的切口。结果良性病灶均完全切除。1例选择病灶表面皮肤穿刺活检,该患者B超、钼靶、临床均高度怀疑乳腺癌,但巴德针穿刺活检阴性;1例因2处触诊不可及的可疑病灶而选择乳房表面2处切口,并且分别使用2把活检刀;3例选择乳房表面病灶附近的切口;乳晕切口32例;腋下皮纹线切口75例;其余285例均选择在腋中线切口。术后病理：乳腺纤维腺瘤299例,乳腺增生病伴纤维腺瘤样结构形成47例,乳腺导管内乳头状瘤11例,乳腺囊性增生病26例,乳腺潴留囊肿8例,重度不典型增生2例,导管内癌1例,浸润性导管癌3例。3例浸润性导管癌,其中2例肿物位于左乳肿物外上象限距离乳头1 cm,择期行乳癌根治术;1例肿物在右乳外上象限距乳头3 cm,择期行保乳术联合腋窝淋巴结清扫术。 B超术前BI-RADS分类与术后病理对比,阳性预测值75．0％（3/4）,误诊率（假阳性）0．2％（1/393）,漏诊率（假阴性）25．0％（1/4）,准确率99．5％（395/397）。393例良性病变随访6～24个月,切口隐蔽,愈合良好,乳腺外形美观。结论拟诊为良性的病灶优先考虑美容效果选腋下皮纹线、腋中线、乳晕切口;拟诊为恶性的病灶应尽可能选择病灶附近的切口。     

Ultrasound-guided, vacuum-assisted excision in the diagnosis and treatment of clinically benign breast lesions

INTRODUCTION

Ultrasound-guided, vacuum-assisted biopsy has a definitive role in the diagnosis of breast lesions. Its role in the treatment of benign breast lesions like fibroadenomas has not been established.

PATIENTS AND METHODS

This is a retrospective review of patients undergoing ultrasound-guided, vacuum-assisted biopsy for clinically benign breast lesions. The procedures were performed in all cases by two consultant radiologists with special interest in breast radiology between February 2002 and January 2004. Patients were followed up in the clinic 6 weeks after the procedure.

RESULTS

Seventy-six patients had ultrasound-guided, vacuum-assisted excision of clinically benign breast lesions during this 2-year period. Mean age of the patients was 31 years. Altogether, 86 procedures were performed. Six patients with larger lesions (> 2 cm) had two procedures on separate sitting and 4 patients had separate lesions excised on a later date. Fifty-six patients were identified to have fibroadenomas and had complete excisions as evidenced on scan. Three out of nine patients identified with equivocal disease on fine needle aspiration cytology (FNAC) were found to have cancer following ultrasound-guided, vacuum-assisted excision. One patient who was diagnosed with cancer on FNAC, proved to be fibroadenoma on final histopathology. Four patients developed haematomas following ultrasound-guided, vacuum-assisted excision and all were managed conservatively.

CONCLUSIONS

Our study shows that ultrasound-guided, vacuum-assisted excision can play an efficient role in the diagnosis of benign breast lesions and is a safe and successful alternative in treatment of fibroadenomas.     

MRI引导下乳腺病灶真空辅助穿刺活检术的应用

目的探讨MRI引导真空辅助穿刺活检术在BI-RADS 4类乳腺病变中的应用价值。方法对9例MRI诊断为BI-RADS 4类乳腺病变的患者行MR引导真空辅助穿刺活检术。采用1.5T MR仪,8通道专用乳腺MR活检线圈,乳腺适度加压后固定于定位装置内;定位扫描采用矢状位3D动态增强扫描,将数据传至乳腺活检专用定位工作站,由工作站自动计算活检位置及进针深度。以14.5cm、8G真空辅助活检针进行穿刺。结果 9例中,8例病灶准确定位,并成功取得组织病理结果;1例因病灶位置表浅、工作站不能定位而终止活检。每例取组织6~20条,共取96条;每例操作时间为30~65min。组织病理学结果:乳腺浸润性导管癌2例,腺病3例,导管内乳头状瘤1例,硬化性腺病合并导管扩张1例,腺病伴不典型增生1例。结论 MR引导下乳腺病变真空抽吸活检术用于BI-RADS 4类乳腺病变安全可行,能够取得足够的组织用于病理学评估。