立体定位导丝导向活检不能触及的乳腺病灶

目的 探讨立体定位导丝导向活检不能触及的乳腺病灶的价值。方法 对25例不能触及的乳腺病灶行立体定位导丝导向活检26处,对每处病灶计算出穿刺针针尖至病灶中心的距离（D）,并直接测量出留置的导丝头端至病灶中心的距离作对照,判断标准：优：D小于等于2．5mm;良：D＝2．6－4．9mm;差：D大于等于5．0mm。结果 定位优20例次,良5例次,差1例次。穿刺针针尖至病灶中心距离的计算值与直接测量值相符,1次性病灶切除26例次,标本体积的中位数为10．5cm3,检出乳腺癌6（6／26）处;结论 立体定位导丝导向活检不能触及的乳腺病灶能以最小的手术范围完整切除病灶,定位定性效果确切,可避免假阴性,提高了乳腺癌的早期检出率及诊断准确性。     

Marking of nonpalpable breast lesions using a custom carbon suspension

Purpose: To review results of carbon marking in non-palpable breast lesions using a different type of a carbon suspension containing 0.5% polyoxyethylene sorbitan monooleate (PSM).Material and Methods: Sixteen lesions of 16 patients with indeterminate or suspicious mammographic findings underwent stereotaxic carbon marking. With the aid of tracing of the carbon stains surgery was then performed.Results: Pathology revealed malignancy in 26% of the cases and the missed rate by carbon marking was 6% (1 lesion). Carbon marking is an easier application compared to hook-wire systems in localizing occult breast lesions. PSM added to a 4% carbon suspension results in a more homogeneous suspension, prevents early precipitation and eases injection. Animal studies have shown that no local or peripheral tissue reactions are elicited with either pure PSM or in a mixture with carbon.Conclusion: We recommend addition of PSM to carbon marking suspensions.     

An experience with the Advanced Breast Biopsy Instrumentation (ABBI) system in the management of non-palpable breast lesions

Our objective was to evaluate our experience with the Advanced Breast Biopsy Instrumentation system (ABBI) in non-palpable breast lesions in a prospective study from July 1998 to November 2000. The ABBI system was included in a protocol for BIRADS 4 non-palpable, small (<15 mm) breast lesions. Digital radiographs of both specimen and biopsy cavity were obtained to validate the procedure. A total of 255 ABBI biopsies were performed in 254 patients. In 251 cases the lesions were successfully removed (98.4%). Mammographic lesions consisted of 176 cases of microcalcifications (69%), 51 cases of architectural distortions (20%) and 28 cases of nodules (11%). Seventy-two carcinomas were diagnosed (28.2%). Affected margins were found in 41 cases (56.9%). Residual tumour was seen in 31 patients (43%). Seventeen borderline results and 33 benign architectural distortions obviated further procedures. The complication rate in 10 cases was as follows: 3 wound infections; 4 haematomas; and 3 vasovagal reactions. The main utility of the ABBI system is to allow a reliable diagnosis in complex lesions, such as small clusters of microcalcifications and especially architectural distortions. Surgery can be avoided for borderline cases if the lesion is completely removed and free margins are obtained in the pathology study. Therapeutic use is controversial and can be applied only in selected cases.     

The impact of stereotactic large-core needle biopsy in the treatment of patients with nonpalpable breast lesions: a study of diagnostic accuracy in 510 consecutive cases

The objective of this study was to assess the usefulness of stereotactic large-core needle biopsy (LCNB) in the management of nonpalpable breast lesions (NBL) and compare it with stereotactic fine-needle aspiration biopsy (SFNA) performed simultaneously in a significant number of cases. From November 1993 through June 1997, 510 consecutive patients with NBL underwent 14-gauge LCNB with 354 women undergoing simultaneous 21-gauge SFNA in the same lesion. Mammographic findings, lesion size, number of core biopsy specimens, complications and diagnoses of both techniques were analysed. Surgical biopsy, tumorectomy or mastectomy was indicated for malignancy or poor correlation between SFNA or LCNB results and clinical or radiological findings. Values of diagnostic accuracy of both LCNB and SFNA were determined. The ratio benign surgical biopsies/malignant surgical biopsies (BB/CB) of the series was calculated. A total of 171 patients underwent surgical treatment; in 31 (18.1 %) a benign process or atypical ductal hyperplasia was the final diagnosis. The ratio BB/CB was 0.22. Sensitivity and specificity were 93.2 and 100 %, respectively, for LCNB, and 77.2 and 92.3 %, respectively, for SFNA with cytological analysis. Large-core needle biopsy provides more accurate diagnosis than SFNA in the management of nonpalpable breast lesions and obviates a surgical diagnostic procedure in a significant number of cases. Received 17 November 1997; Revision received 4 February 1998; Accepted 16 March 1998     

MR-guided percutaneous excisional and incisional biopsy of breast lesions

The aim of this study was the realisation and clinical application of MR-guided vacuum biopsy for percutaneous excisional and incisional biopsy of enhancing breast lesions. A breast biopsy system and procedure have been developed which allow precise and safe access to breast lesions in any location and use of vacuum biopsy (VB) under MR guidance. Fifty-one patients with 55 MR-detected lesions were examined. Verification of these diagnoses included re-excision histology of all 14 malignancies and for benign lesions retrospective correlation of histology and imaging, assessment of complete or partial removal of the enhancing area directly after VB (40 of 40 lesions) and follow-up MRI (33 of 40 lesions), which in contrast to conventional needle biopsy can be used as proof of representative removal. Fifty-four of 55 procedures (including 15 lesions ≤ 5 mm and another 26 lesions of 5–10 mm size) were successful. One failure was caused by incorrect use of the VB gun. Vacuum biopsy yielded 14 malignancies and 40 benign lesions. With the available verification techniques all diagnoses proved correct. Percutaneous VB became possible under MR guidance. With minimal invasion it allowed increased certainty and accuracy even for very small lesions. Received: 17 August 1998; Revised: 15 January 1999; Accepted: 10 February 1999     

Imaging-histologic discordance at sonographically guided percutaneous biopsy of breast lesions

OBJECTIVE: To determine the frequency of imaging-histologic discordance at percutaneous breast biopsy and to evaluate differences in clinical and radiologic findings between pathologically upgraded lesions and non-upgraded lesions. MATERIALS AND METHODS: From February 2000 to June 2005, we reviewed 386 cases that had suspicious imaging findings but yielded benign histology at US-core needle biopsy and that underwent subsequent excisional biopsy. In 74 of 386 cases, the benign histology at core needle biopsy could not provide a satisfactory explanation for the radiologically suspicious lesions. The clinical, radiologic and histologic findings were reviewed for those 74 cases that were classified as the upgrade group and the non-upgrade group after excisional biopsy. RESULTS: The upgrade rate was 17.6% (95% confidence interval, 10.6-27.8%, 13 of 74 cases) revealed upgraded pathology at the subsequent excisional biopsy. Besides the size of masses, there were no statistically significant differences in imaging findings between the upgrade and non-upgrade groups at excisional biopsy. CONCLUSION: This upgrade rate of 17.6% suggests that excisional biopsy or re-biopsy is warranted in those cases presenting imaging-histologic discordance at US-guided core biopsy.     

钼靶乳腺摄影与高频超声诊断乳腺隐匿性病变的可行性及其互补作用

目的探讨钼靶摄片和超声影像对乳腺隐匿性病变的诊断价值以及互补作用。方法收集69例乳腺隐匿性病变的临床资料,所有病例均同时接受了全数字乳腺钼靶摄片和高频超声影像检查,其中至少有一种诊断结果为BI-RADS4～5级,并且均有细针立体定位手术活检病理诊断结果。结果 69例中分别有63例和22例被钼靶和超声诊断为BI-RADS4～5级,而两种诊断均为4～5级的有16例。69例中32例活检病理证实为乳腺癌。63例乳腺钼靶诊断为4～5级病例中有31例病理证实为乳腺癌,而6例诊断为0～3级的病例中仅有1例病理证实为乳腺癌,该病例被超声诊断为5级;超声诊断为4～5级的22例病例有14例为乳腺癌,而另外47例超声诊断为0～3级的病例中有18例病理证实为乳腺癌,两种检查方法对乳腺癌的检出率之间存在显著的统计学差异(χ2=11.19,P=0.004)。结论钼靶摄片对诊断乳腺隐匿性病变是否为癌的可靠性要显著优于超声影像,但是两者联合则能提高其检出率。     

MR imaging-guided axillary node biopsy for breast cancer: initial findings

The aim of this study was to evaluate the usefulness and feasibility of preoperative sentinel node needle biopsy of the breast under guidance of open MR imaging, a method that we developed. Nine patients with breast cancer in whom the axillary lymph nodes were not palpable underwent preoperative sentinel node needle biopsy under real-time MR imaging guidance. The sentinel nodes were identified before the biopsy using CT and MR imaging. Diagnostic ability of this method was compared with that of the operative diagnosis. Sentinel nodes were correctly identified in all 9 patients. The MR imaging-guided sentinel node needle biopsy was performed for all of the 9 patients, and, in 7 (77.8%) of the 9, a specimen sufficient for pathologic evaluation was obtained; and in 6, whether malignancy existed was precisely diagnosed. No serious complications were noted. This experience indicates the possibility of a precise diagnosis of whether the sentinel node in breast cancer is benign or malignant without surgery.     

乳腺立体定位核芯针活检的病理组织学低估原因分析

目的 分析乳腺立体定位核芯针活检的病理组织学低估的原因,以期引起临床多学科的重视及客观对待.方法 2000年9月至2005年9月,对146例乳腺病变患者(179个病变)进行立体定位核芯针病变部位穿刺活检,发生病理组织学低估21个.病变均不可触及(NPBL),根据乳腺影像报告和数据系统(BI.RADS),活检前诊断BI-RADS m类6个,Ⅳ类12个,V类3个,影像表现为钙化16个,肿块2个,不对称性致密1个,星芒征2个.结果 活检为纤维囊性乳腺病并导管上皮不典型增生11个,手术诊断为导管原位癌7个,伴早期浸润4个;活检为重度乳腺导管不典型增生3个,手术诊断为原位癌1个,原位癌伴早期浸润2个;活检为乳腺导管原位癌3个,手术证实均为浸润性癌;活检为乳头状病变4个,手术证实为原位癌及伴早期浸润各1个、浸润性导管癌及乳腺导管内乳头状腺癌各1个.结论 乳腺核芯针活检的病理组织学低估与立体定位技术、病变本身及医师的认识有关,放射科医师应熟练掌握活检技术并力求全面取材,当穿刺活检结果与影像表现不符时,应重新评价病变的实际病理诊断.     

Impact of stereotactic 11-g vacuum-assisted breast biopsy on cost of diagnosis in Austria

Purpose

To determine the frequency with which stereotactic 11-g vacuum-assisted breast biopsy (11-g SVAB) obviates an open surgical biopsy (OSB), to compare the costs of these two biopsy methods, and to estimate the potential cost savings attributable to 11-g SVAB in the diagnosis of suspicious breast lesions in patients in Austria.

Materials and methods

We retrospectively reviewed 318 consecutive breast lesions of BI-RADS categories IV and V (microcalcifications n = 166; masses n = 152) on which 11-g SVAB and OSB were performed. Cost savings were calculated using nationally allowed flat rates and patient charges. Costs were measured from a hospital and a socioeconomic perspective. Common clinical scenarios and sensitivity analyses assessed the extent of achievable cost savings.

Results

11-g SVAB obviated the need for an OSB in 93 (29%) of 318 women. Overall cost savings per 11-g SVAB over OSB were € 242 per case from a hospital perspective, and € 422 per case from a socioeconomic perspective. The use of 11-g SVAB decreased the cost of diagnosis by 7% from a hospital perspective, and by 10% from a socioeconomic perspective.

Conclusion

In Austria, annual national savings of over 5 million Euro could be realized with the use of 11-g SVAB for the diagnosis of suspicious breast lesions. Although savings per case are modest, the national health care system realizes significant cost reduction as women benefit from a faster and less invasive approach to diagnosis.     

MRI诊断扪诊阴性的乳腺占位性疾病

目的：评价ＭＲＩ诊断扪诊阴性的乳腺疾病的敏感性、特异性并探讨其临床意义。材料与方法：应用ＭＲ快速小角度激发三维成像（ＦＬＡＳＨ－３Ｄ）对２６例Ｂ超或Ｘ线检查提示或怀疑有占位，而临床检查未扪及肿块病人的乳腺进行常规及动态检查。结果：发现孤立性病灶２１个，根据病灶形态、边缘、信号均匀度及增强前后信号的动态变化确定典型癌性病变４例，典型良性病变１１例，非典型病变１１例。经病理学对照，本组病例ＭＲＩ的敏感性为１００％，特异性６５％。结论：对于典型良、恶性病变，ＭＲＩ的特异性较高，尽管对非典型良、恶性病变重叠较大，但ＭＲＩ为这类病变提供了细胞学检查和预防性手术的影像学依据。     

立体定位核芯针活检在乳腺疾病诊断中的应用研究

目的探讨乳腺微小病变行立体定位核芯针活检（SCNB）的临床应用价值。方法采用计算机辅助乳腺三维立体定位系统、弹射式活检枪和16G核芯针，对47例乳腺X线发现的可疑恶性病变直接行穿刺活检，记录每例的临床和X线表现（钙化、结节、结构紊乱等）、穿刺活检诊断、外科术后病理诊断或随访观察资料。比较SCNB与外科手术二者的病理诊断结果，统计其诊断符合率。对照分析SCNB准确性与病灶X线表现的关系，分析SCNB成败、误诊原因。结果欲行SCNB47例，成功完成44例，未能完成3例。31例患者随后行外科手术，SCNB诊断与术后病理符合27例，4例SCNB与术后病理不符。结论SCNB具有准确、快速、微创等优势，可减少手术活检数量，及早确诊乳腺疾病，具有良好的临床应用前景。     

Cost comparison between ultrasound-guided 14-g large core breast biopsy and open surgical biopsy: An analysis for Austria

Purpose

To examine the budget impact of ultrasound-guided 14-g large core breast biopsy (US-guided LCBB) by comparing the costs of US-guided LCBB and open surgical biopsy (OSB); to calculate the cost savings attributable to US-guided LCBB; and to assess the frequency with which US-guided LCBB obviates the need for an OSB.

Materials and methods

In a retrospective study, we reviewed 399 suspicious breast lesions on which US-guided LCBB and OSB or, in cases of benign histology, clinical follow-up, were performed. Cost savings were calculated using nationally allowed flat rates (A-drg) and patient charges. Costs were measured from both, a hospital and a socioeconomic perspective. Deterministic sensitivity analyses were simulated to assess the extent of achievable cost savings.

Results

Overall cost savings for US-guided LCBB over OSB were €977 (€2,337/€3,314) per case from a hospital perspective, resulting in a total cost decrease of 30% for the diagnosis of suspicious breast lesions. From a socioeconomic perspective, cost savings were €1,542 (€2,600/€4,142) per case, resulting in a 37% reduction in biopsy cost. US-guided LCBB obviated the need for a surgical procedure in 240 (60%) of 399 women. In all four sensitivity analyses, costs of US-guided LCBB remained lower than that of OSB.

Conclusion

From an economic perspective, US-guided LCBB is highly recommended for the diagnosis of suspicious breast lesions, as this procedure reduces the cost of diagnosis substantially. In Austria, annual cost savings would be €18.5 million.     

全数字化X线立体定位及活体组织检查对诊治乳腺不可触及病变的价值

目的：探讨全数字化X线立体定位及活体组织检查对临床不可触及乳腺病变（NPBL）的诊断及应用价值。方法95例临床触诊阴性乳腺数字钼靶摄片发现微小病变。乳腺影像报告和数据系统（BI-RADS）分级4或4以上。27例行立体定位穿刺活检（SCNB）;68例行立体定位下导丝引导活检（SNLB）。结果27例SCNB,25例病理结果一致,2例病理结果低估,活检符合率92％。68例SNLB均定位成功,病变完全切除,符合率100％。结论 SCNB使乳腺良性病变切取数目降到最低,创伤小、费用低,诊断准确率高。SNLB获得的病理诊断准确、可靠。两者相比较SNLB弥补了SCNB的取材不足及假阴性,能够获得可靠的病理结果,一次同时完成诊断和治疗。     

全数字化乳腺X线摄影对乳腺肿块的良恶性鉴别价值

目的:探讨全数字化乳腺X线摄影图像特点对乳腺肿块定性诊断的价值。方法:收集185例经病理证实以肿块为主的乳腺病患者的临床和影像资料,对222个病灶的形态、边缘、密度、大小及周围结构改变的发生率分别进行统计分析。结果:肿块的形态、边缘、密度及周围结构扭曲、伴随病理结构在良恶性病变间差异有统计学意义(P0.05),特别是肿块边缘征象及周围结构改变对肿块良恶性具有鉴别诊断价值。边缘清晰、周围结构正常在良性病变中明显高于恶性病变;边缘模糊、毛刺及周围结构扭曲、紊乱,伴随病理结构在恶性病变中明显高于良性病变,差异有统计学意义(P0.05)。以2cm为界,肿块大小对病变定性差异无统计学意义(P=0.235)。结论:乳腺X线摄影对良恶性肿块具有重要鉴别诊断价值。     

Stereotactic large-core needle breast biopsy: analysis of pain and discomfort related to the biopsy procedure

The purpose of this study was to determine the significance of variables such as duration of the procedure, type of breast tissue, number of passes, depth of the biopsies, underlying pathology, the operator performing the procedure, and their effect on women’s perception of pain and discomfort during stereotactic large-core needle breast biopsy. One hundred and fifty consecutive patients with a non-palpable suspicious mammographic lesions were included. Between three and nine 14-gauge breast passes were taken using a prone stereotactic table. Following the biopsy procedure, patients were asked to complete a questionnaire. There was no discomfort in lying on the prone table. There is no relation between type of breast lesion and pain, underlying pathology and pain and performing operator and pain. The type of breast tissue is correlated with pain experienced from biopsy (P = 0.0001). We found out that patients with dense breast tissue complain of more pain from biopsy than patients with more involution of breast tissue. The depth of the biopsy correlates with pain from biopsy (P = 0.0028). Deep lesions are more painful than superficial ones. There is a correlation between the number of passes and pain in the neck (P = 0.0188) and shoulder (P = 0.0366). The duration of the procedure is correlated with pain experienced in the neck (P = 0.0116) but not with pain experienced from biopsy.