乳腺X线立体定位穿刺活检术

乳腺Ｘ线立体定位穿刺活检术王庆全,鲍润贤,杨建梅,青春,曹旭晨,姚秉瑜天津医科大学附属肿瘤医院放射科（天津市　３０００６０）摘要目的：乳腺Ｘ线立体定位穿刺活检,是９０年代在电子计算机辅助下开展起来的一种新的乳腺检查方法。方法：它是在常规乳腺Ｘ线片观察...     

乳腺X线立体穿刺钢丝定位活检术的临床应用

目的:探讨乳腺X线立体穿刺钢丝定位活检术在不能触及乳腺病灶中的临床应用价值。方法:对58例钼靶X片上有可疑病灶而无临床体征的患者,通过X线立体定位穿刺,放入钢丝标记,指导外科切除活检,组织病理学检查明确诊断。结果:58例不能触及乳腺病灶一次定位切检成功,经病理检查证实恶性病变20例,良性病变38例。结论:乳腺X线立体穿刺钢丝定位活检术对不能触及乳腺病灶的定位定性诊断有重要价值,是诊断无体征早期乳腺癌的理想诊断技术。     

X线立体定位下乳腺粗针穿刺活检在乳腺微小病变诊断中的应用

乳腺癌是女性最常见的恶性肿瘤。乳腺Ｘ线照相可发现一些乳腺微小病变,为明确这些病变的性质,往往需行乳腺手术活检。Ｓｉｃｋｌｅｓ[1]报道约2～4%的病人因乳腺像检查提示有可疑癌变而行外科手术活检,而这些病变中有70～90%为良性。因此寻找一种简单可靠、损伤性小的诊断方法已成为必要。Ｘ线立体定位下乳腺粗针穿刺活检(Ｓｔｅｒｅｏｔａｃｔｉｃｎｅｅｅｄｌｅｃｏｒｅｂｉｏｐｓｙ,ＳＣＮＢ)为近年来发展起来的诊断方法之一,越来越受到广泛重视,在欧美一些国家已被普遍应用。本文就这一技术的适应证、方法和临床应用等方面进行介绍。1.…     

X线立体定位下核芯针穿刺活检诊断早期乳腺癌

乳腺癌是女性最常见的恶性肿瘤。乳腺X线照相可发现一些乳腺微小病灶，为明确这些病变的性质，往往需行乳腺手术活检。Sickles报道约2％～4％的病人因乳腺X线检查提示有可疑癌变而行外科手术活检，而这些病变当中有70％～90％为良性。因此寻找一种简便、实用、微创的诊断方法至关重要。X线立体定位下乳腺组织核芯针穿刺活检（stereotaetic core needle biopsy，SCNB）为近年来乳腺癌研究的热点之一，越来越受到广泛重视，在西方国家已被普遍应用。本文将该项技术的临床应用进展综述如下。     

乳腺钼靶摄片立体穿刺钢丝标记定位活检术

我院从 1995年开展乳腺钼靶摄片立体穿刺钢丝标记定位活检术 ,认为这是一个较好的方法 ,报告如下 :一　材料与方法1 一般资料　病例 6例为 1995～ 1998年我院收治的女性住院病人 ,钼靶摄片为可疑恶性病灶 ,无体征。表明为 :2例见星形结节影 ,4例见砂粒样钙化点。 4例乳腺癌 ,平均年龄 43岁 (36～ 5 3岁 ) ;2例为良性病变 ,年龄 37岁 (2 9～ 45岁 )。2 定位标记材料　Ｐｌａｎｍｅｄ钼靶乳腺摄片机及配套的有孔压迫器 ,9号穿刺针 ,自制的标记钢丝 (用硬膜外麻醉管的内衬钢丝或小提琴弦制成 )。3 标记定位及活检方法　手术前采用立体定位仪在…     

数字化X 线立体定位真空辅助活检术诊断T0期乳腺癌的临床研究*

目的:探讨数字化X 线立体定位真空辅助活检术对临床触诊阴性乳腺癌的早期诊断价值。方法:2007年10月至2009年9 月南方医科大学附属深圳市妇幼保健院应用Lorad数字化钼靶机和Lorad Multicare俯卧式活检系统引导Vacora 对243 例临床不可触及的可疑病灶（BI-RADS 评级为Ⅳ级及以上）行真空辅助活检术。结果:活检成功率为99.6%（242/243）,手术时间20～60min,中位时间32min。术后病理:乳腺导管内癌21例、导管内癌伴微浸润7 例、浸润性导管癌2 例、浸润性小叶癌1 例;病理分期:0 期21例、Ⅰ期9 例、ⅡA 期1 例;乳腺导管上皮不典型增生22例,占活检总数的9.1% 。术后出现皮下瘀斑15例、血肿形成11例,未见其他严重手术并发症。结论:数字化俯卧式穿刺活检定位系统引导Vacora 真空负压辅助活检系统（10G）对钼靶下的乳腺微小病灶的活检术,具有活检定位精准、手术成功率高、创伤小等特点,对T0 期乳腺癌的早期诊断有较高的临床应用价值。      

全数字化俯卧式X 线立体钢丝定位术在乳腺微钙化病灶中的应用价值*

目的:探讨X 线立体定位钢丝引导切取活检术（SWLB）对乳腺微钙化病灶的临床应用价值。方法:回顾性分析2007年5 月至2008年5 月南方医科大学附属深圳妇幼保健院45例行SWLB 活检的乳腺隐匿性病变,所有病例均为临床触诊阴性而乳腺X 线摄影发现微钙化病灶,将活检标本病理结果与X 线表现进行对照。结果:45例SWLB 活检组织标本病理结果中恶性病变13例（28.9%）,其中包括导管原位癌3 例（23.1%）,导管原位癌伴微浸润4例（30.8%）,浸润性导管癌5 例（38.5%）,导管内乳头状癌1 例（7.7%）;良性病变32例（71.1%）,其中包括导管上皮重度非典型增生2 例（6.3%）。 结论:SWLB 可准确引导切检临床阴性的乳腺微钙化病灶,明确乳腺微钙化的性质,提高早期乳腺癌的检出率。      

立体定位穿刺活检术在诊断乳腺微小病变中的临床价值

[目的]探讨乳腺X线立体定位穿刺活检技术对乳腺微小病变（NPBL）的诊断价值。[方法]采用美国GE钼铑双靶X线机及数字化三维立体定位穿刺活检系统对40例临床不可触及的NPBL患者先行立体定位穿刺活检（SCNB）,再行立体定位细针引导切检（SNLB）,比较SCNB与SNLB的病理检查结果。[结果]40例NPBL患者,均进行了SCNB和SNLB技术处理,无一例发生并发症。SCNB诊断准确率为95%（38/40）,诊断早期乳腺癌的敏感度为84.6%（11/13）,特异性为100.0%（27/27）。[结论]SCNB技术创伤小,操作简便,既可提高早期乳腺癌的诊断率,又避免了良性病变手术活检的痛苦,值得临床应用。     

X线引导下经皮肺穿刺活检46例

[目的]探讨X线引导下经皮肺穿刺活检的技术,适应证的选择及临床应用价值.[方法]通过肺部病变病人的X线胸片、CT片,了解肿物在肺内大小及位置,确认穿刺平面及最佳穿刺路径.在X线监视下穿刺预定位置后,确认无误即行抽吸取材送病理检查.[结果]所有病例取材满意,46例病人穿刺活检38例病理确诊.1例为霉菌感染,3例肺脓肿,1例结核,阳性率达93.4%,有2例穿刺后并发症发生.[结论]X线引导下经皮肺穿刺定位准确,安全可靠,操作简便,特异性及准确性高,可得到明确的病理学诊断,值得临床推广应用.     

数字化立体定位活检在乳腺病变诊断中的应用

数字化立体定位活检包括立体定位穿刺活检 (stereotacticneedlecorebiopsy ,SCNB)和立体定位细针引导切检 (stereotacticmammographyneedlelocalizedbiopsy ,SNLB) ,是诊断不可触及的乳腺病变的重要方法。我们自 2 0 0 0年 6月至 2 0 0 2年 6月 ,对 92例患者进行了立体定位活检 ,现将结果分析报告如下。一、资料与方法1.一般资料 :全组 92例患者均为女性 ,年龄 19～ 72岁。均未触及明确肿块。对 5 6例进行SCNB ,36例进行SNLB。活检指征 :乳腺片显示有下列特征之一者 :(1)伴有或不伴有肿块的细沙样钙化 ;(2 )孤立的结节 ;(3)局限性致…     

临床触诊阴性的乳腺内微小病灶的外科活检

目的探讨应用乳腺摄片结合定位系统，对临床触诊阴性的乳腺内微小病变进行穿刺定位乳腺活检术的价值。方法回顾性分析总结82例临床触诊阴性、乳腺摄片发现乳腺的微小病变患者，实行穿刺定位引导下行外科切除活检术。结果82例患者均一次性手术切除病灶，金属定位线完整取出，无1例并发症，术后诊断乳腺癌22例（26．50％），余60例为良性病变。结论金属线定位行外科活检，是临床触诊阴性乳腺内微小病变定性诊断的有效方法，安全可靠。术前准确定位，病灶完全切除，术中冷冻准确是其成功关键。     

触诊阴性乳腺病灶术中冰冻诊断的可行性分析

 目的 探讨触诊阴性乳腺病灶活检术中冰冻诊断的准确性与可行性。方法 由钼靶发现的触诊阴性乳腺病灶158例，采用金属线定位技术切除活检，术中进行冰冻切片与诊断，以石蜡组织学诊断为准，评价冰冻诊断的准确性。结果 158例标本中，病理巨检时仅80例（50．6％）发现肉眼可见的异常病灶，平均长径1．2cm。石蜡组织学诊断乳腺浸润癌15例，微小浸润导管癌15例，原位癌12例，导管上皮不典型增生5例，占29．7%（47／158）。术中冰冻对乳腺浸润癌诊断的准确率为93．3％，对微小浸润癌、原位癌、导管上皮不典型增生诊断的准确率分别为60％、58．3％与60％，误诊均为假阴性与低估诊断，无假阳性与过度诊断，原因主要为切片误差与解释错误。结论 冰冻切片对浸润性乳腺癌诊断的准确率高，可用于指导触诊阴性乳腺病灶活检术中手术方案的选择，而对微小浸润癌、原位癌及导管上皮不典型增生常出现假阴性与低估诊断，应待石蜡组织学诊断后再决定手术方案。     

X线立体定位活检在触诊阴性的乳腺微小病灶中的应用

目的 探讨乳腺X线及立体定位活检在临床触诊阴性的乳腺内微小病灶的应用价值.方法 回顾性分析81例临床触诊阴性而乳腺摄片发现微小病变并进行立体定位穿刺活检患者的病例资料.结果 81例中乳腺良性病变58例(71.6%),恶性病变23例(28.4%).结论 临床触诊阴性的乳腺微小病变应积极活检,乳腺X线及立体定位活检术是提高早期乳腺癌检出率的有效方法并能指导治疗和选择最佳的手术方式.     

超声引导下粗针活检术诊断不可触及乳腺病变的研究

目的：评价超声引导下粗针活检术（US－CNB）对不可触及的乳腺病变（NPBL）的诊断意义。方法：对138例女性患者的162处NPBL进行US－CNB和切除活检,以切除活检病理结果为诊断标准。结果：NPBL大小为3－24mm(平均11．1mm）。在US－CNB标本中,142处为良性,3处为可疑恶性,14处为恶性,3处取材不当,在手术切除标本中,18处为恶性,144处为良性。US－CNB取材不当的3处均为良性。US－CNB诊断阳性率为94．44％（17／18）,特异性为100．00％（141／141）,正确率为99．37％（158／159）。结论：US－CNB诊断NPBL安全、创伤小、准确率高。     

Stereotactic Vacuum-Assisted Core Biopsy Results for Non-Palpable Breast Lesions

Background: The increase in breast cancer awareness and widespread use of mammographic screening has led to an increased detection of (non-palpable) breast cancers that cannot be discovered through physical examination. One of the methods used in the diagnosis of these cancers is vacuum-assisted core biopsy, which prevents a considerable number of patients from undergoing surgical procedures. The aim of this study was to present the results of stereotactic vacuum-assisted core biopsy for suspicious breast lesions. Materials and Methods: Files were retrospectively scanned and data on demographic, radiological and pathological findings were recorded for patients who underwent stereotactic vacuum-assisted core biopsy due to suspicious mammographic findings at the Interventional Radiology Centre of the Florence Nightingale Hospital between January 2010, and April 2013. Statistical analysis was carried out using Pearson’s Chi-square, continuity correction, and Fisher’s exact tests. Results: The mean age of the patients was 47 years (range: 36-70). Biopsies were performed due to BIRADS 3 lesions in 8 patients, BIRADS 4 lesions in 77 patients, and BIRADS 5 lesions in 3 patients. Mammography elucidated clusters of microcalcifications in 73 patients (83%) and focal lesions (asymmetrical density, distortion) in 15 patients (17%). In terms of complications, 1 patient had a hematoma, and 2 patients had ecchymoses (3/88; 3.3%). The histopathologic results revealed benign lesions in 63 patients (71.6%) and malignant lesions in 25 patients (28.4%). The mean duration of the procedure was 37 minutes (range: 18-55). Although all of the BIRADS 3 lesions were benign, 22 (28.6%) of the BIRADS 4 lesions and all of the BIRADS 5 lesions were malignant. Among the malignant cases, 80% were in situ, and 20% were invasive carcinomas. These patients underwent surgery. Conclusions: In cases where non-palpable breast lesions are considered to be suspicious in mammography scans, the vacuum-assisted core biopsy method provides an accurate histopathologic diagnosis thus preventing a significant number of patients undergoing unnecessary surgical procedures.     

Lateral Decubitus Positioning Stereotactic Vacuum-Assisted Breast Biopsy with True Lateral Mammography

Stereotactic vacuum-assisted breast biopsy (VAB) has been used to evaluate microcalcifications or non-palpable breast lesions on mammography. Although stereotactic VAB is usually performed in a prone or upright position, an expensive prone table is necessary and vasovagal reactions often occur during the procedure. For these reasons, the lateral decubitus position can be applied for stereotactic VAB, and true lateral mammography can be used to detect the lesion. We report on 15 cases of lateral decubitus positioning for stereotactic VAB with true lateral mammography for non-palpable breast lesions or microcalcifications. The mean procedure time was approximately 30.1 minutes, and no complications occurred during the procedures. Fourteen cases had benign breast lesions and one case had a ductal carcinoma in situ. The lateral decubitus stereotactic VAB with true lateral mammography can be applied for microcalcifications or non-palpable breast lesions and helps to minimize anxiety and vasovagal reactions in patients.     

T_0乳腺癌(附23例临床病理报告)

１９８７年以来通过联合诊断发现Ｔ０乳腺癌２３例，多有一定易感因素，且乳房出现不同程度的细微变化，甚至腋窝淋巴结肿大。均手术治疗，１例乳腺内未发现癌灶，腋窝淋巴结转移３０％。提出Ｔ０乳腺癌多为早期癌，但又不完全是早期癌。强调应重视乳腺癌的易感因素及乳房的细微变化，对乳腺组织切检宜放宽指征，提倡联合诊断。     

Nonpalpable breast carcinomas: long-term evaluation of 1,258 cases

Introduction.

In recent decades, a steady improvement in imaging diagnostics has been observed together with a rising adherence to regular clinical breast examinations. As a result, the detection of small clinically occult (nonpalpable) lesions has progressively increased. At present in our institution some 20% of the cases are treated when nonpalpable. The aim of the present study is to analyze the characteristics and prognosis of such tumors treated in a single institution.

Methods.

The analysis focused on 1,258 women who presented at the European Institute of Oncology with a primary clinically occult carcinoma between 2000 and 2006. All patients underwent radioguided occult lesion localization (ROLL), axillary dissection when appropriate, whole breast radiotherapy, or partial breast intraoperative irradiation and received tailored adjuvant systemic treatment.

Results.

Median age was 56 years. Imaging showed a breast nodule in half of the cases and a breast nodule accompanied by microcalcifications in 9%. Microcalcifications alone were present in 17.1% of the cases, whereas suspicious opacity, distortion, or thickening represented the remaining 24.6%. Most tumors were characterized by low proliferative rates (68.9%), positive estrogen receptors (92.3%), and non-overexpressed Her2/neu (91.3%). After a median follow-up of 60 months, we observed 19 local events (1.5%), 12 regional events (1%), and 20 distant metastases (1.6%). Five-year overall survival was 98.6%.

Conclusions.

Clinically occult (nonpalpable) carcinomas show very favorable prognostic features and high survival rates, showing the important role of modern imaging techniques.