False negative breast biopsy for palpable mass

Open breast biopsy is considered to be the most reliable method for the diagnosis of breast cancer in patients with palpable masses. Rarely, after a breast biopsy has been reported to be benign, cancer will be identified at the site of the biopsy. Eight patients were reviewed in whom breast cancer was demonstrated at the site of a previously negative biopsy at intervals ranging between 4 months and 3 years after the original, negative biopsy. Several possible explanations exist to account for this occurrence. The surgeon must be aware that the presence of a mass at the site of prior breast biopsy may be an indication for repeat excision. © 1993 Wiley-Liss, Inc.     

Long-term impact of previous breast biopsy on breast cancer screening modalities

Approximately 80% of breast biopsies are performed for what proves to be a benign process. The patients who undergo these procedures should continue screening with breast physical examination and mammography. The long-term impact of breast biopsy on these screening modalities has not been well studied. We performed a prospective, follow-up evaluation in 63 patients who underwent needle localization biopsy with benign histology at our institution between 6 and 7 years ago. This evaluation consisted of a directed history, breast physical examination, and follow-up mammogram. Two patients (3%) had undergone mastectomy for an interval breast cancer; 17 others (28%) had undergone subsequent biopsies. No patient had changes on physical examination of the biopsy site. All mammograms were evaluated as normal or as having benign abnormalities. Excisional breast biopsy does not generally produce long-term changes affecting the interpretation of breast physical examination or mammography.     

数字化X线定位系统下Mammotome微创活检在乳腺癌早期诊断中的应用

目的:探讨数字化俯卧式X线定位系统下Mammotome微创切除不可触及乳腺病灶在乳腺癌早期诊断的临床应用价值。方法:2004年12月~2005年5月,应用LORAD数字化俯卧式穿刺床X线立体定位系统引导下Mammotome系统对67例患者73个临床不可触及乳腺钼靶X线片表现为可疑病灶进行微创切除活检。73个病灶中X线摄片:42例为孤立簇状聚集钙化,27例为不规则致密影并簇状钙化,4例为局部腺体结构扭曲。术前BIRADS评级Ⅲ、Ⅳ和Ⅴ级分别为51、17和5个。结果:67例患者73个病灶,乳腺癌13个(17.8%),其中4个为乳腺导管内癌,3个导管内癌并早期浸润,6个浸润性导管癌。良性病变60个(82.1%)。13个乳腺癌术后分期:2个为0期,9个为Ⅰ期,2个为ⅡA期,13个中11个为早期乳腺癌(84.6%)。结论:应用LORAD数字化俯卧式X线立体定位系统引导下Mammotome系统微创活检不可触及乳腺X线摄片发现的微小病灶,是一种确诊早期乳腺癌的微创方法。     

麦默通乳腺微创活检术切口的选择

对比426例乳腺病灶选择不同切口的应用效果，针对乳腺不同位置的病灶及根据病灶性质的不同，分别采用腋下皮纹线、腋中线、乳晕及病灶附近切口。结果：绝大部分的切口选择在腋中线切口，其余可根据具体病灶的位置选择腋下皮纹线、乳晕及病灶附近的切口。初步研究结果提示，良性病灶的活检、切除手术可采用腋下皮纹线、腋中线及乳晕切口，以应用腋中线切口为主；恶性可能病灶建议采用就近切口。     

超声BI-RADS3级乳腺不可扪及病变的微创活组织检查

目的探讨超声检查BI-RADS3级的乳腺不可扪及病变（nonpalpable breast lesion,NPBL）微创活组织检查（活检）的临床价值。方法回顾性分析2007年1月至2010年12月在本院接受微创活检、超声BI—RADS3级的542例NPBL病例的临床、影像及病理资料,采用卡方检验比较即时活检组（首次超声诊断后3个月之内活检）与随访活检组（随访6个月后活检）发现恶性病变的概率以及两组恶性肿瘤情况的差异。结果全组542例病例,病理确诊恶性病变5例,总体恶性率为0．92％（5／542）;50—59岁患者的恶性率为9．68％（3／31）,明显高于其他年龄组（20～29岁组0,30～39岁组0．40％,40—49岁组0．57％,60～71岁组0）。即时活检组中恶性病变4例,恶性率为0．91％（4／435）;随访活检组中恶性病变1例,恶性率为0．93％（1／107）,两者差异无统计学意义（P〉O．05）,且两组发现的恶性肿瘤的病灶大小,TNM分期相似。结论超声检查BI—RADS3级的NPBL恶性率低,随访活检是安全的。但对于年龄50岁及以上,超声评估为BI—RADS3级的患者需提高警惕,建议积极进行活检。     

前哨淋巴结活检术在早期乳腺癌保乳术中的应用

目的探讨前哨淋巴结活检术（sentinellymph node biopsy,SLNB）在早期乳腺癌保乳术中的应用效果。方法回顾性分析56例pT1.2N0M0期乳腺癌行保乳术＋前哨淋巴结活检术的临床资料。56例SLN阴性,未行腋窝淋巴结清扫术（axillary lymph node dissection,ALND）。术后辅以化疗、放疗,激素受体阳性患者行内分泌治疗。结果56例成功施行保乳手术,保乳术后双乳对称。SLNB替代ALND者各项术后并发症少。中位随访时间36个月（1～72个月）,1例发现局部复发,行乳腺癌改良根治术时发现腋窝淋巴结转移;1例发现腋窝淋巴结复发转移。结论SLNB可以缩小手术范围,减少术后并发症,保留腋窝形态,提高保乳质量。     

核素示踪乳腺癌前哨淋巴结活检的准确性与可行性

目的:探讨核素示踪乳腺癌前哨淋巴结(SLN)活检的准确性和可行性。方法:1999年4月-2001年10月期间,应用原发肿瘤周围皮下注射放射性核素示踪技术(99mTC-标记硫化锑胶体或99mTC-标记硫胶体),对79例早期乳腺癌患者进行前哨淋巴结活检(SLND),随后,行包括腋窝淋巴结清扫(ALND)在内的根治性手术。分析评估两种核素淋巴示踪和SLND的准确性及其影响因素。结果:75例行术前淋巴闪烁照相,淋巴结显像67例(89.33%,67/75);术中应用γ探测仪成功证实SLNs 68例,成功率为86.08%(68/79),SLN预测腋窝淋巴结状态的准确性为95.59%(65/68),假阴性率为3/36(8.33%);前28例患者有9例不能证实SLN,3例假阴性;而后51例只有2例不能证实SLN,没有假阴性。两者差异有显著性(P<0.05)。结论:本研究结果表明,99mTC-标记硫胶体作为示踪剂,手术当天(术前4-6小时)乳腺肿瘤上方皮下注药进行SLND,可以准确预测早期乳腺癌腋窝淋巴结状态。     

The relationship between holding back from communicating about breast concerns and anxiety in the year following breast biopsy

Purpose: Evidence suggests open communication about breast cancer concerns promotes psychological adjustment, while holding back can lead to negative outcomes. Little is known about the relationship between communication and distress following breast biopsy. Design/ Sample: Women (N = 128) were assessed at the time of breast biopsy and again one week and three, six, and 12 months post-result. Methods: Linear mixed modeling examined relationships between holding back and anxiety for women with benign results (n = 94) or DCIS/invasive disease (n = 34) following breast biopsy. Findings: Anxiety increased among women with a benign result engaging in high but not low or average levels of holding back. Holding back was positively associated with anxiety post-result in breast cancer survivors, with anxiety decreasing over time. Conclusions/ Implications: Interventions to enhance communication are warranted, and knowledge of the differences among women with benign results and/or DCIS/invasive disease may allow for the development of tailored interventions.     

Cardiac injury during needle localized surgical breast biopsy

Needle localized breast biopsy is commonly used to diagnose and remove non-palpable breast lesions. We present the first case of cardiac injury resulting from needle localized breast biopsy. A hooked-end monofilament wire penetrated the pericardium and myocardium overlying the left ventricle. The wire was pulled and the patient managed non-operatively with close monitoring that included plain chest radiographs, electrocardiography, and echocardiography. The literature regarding complications of the procedure was reviewed.     

B超引导Mammotome微创旋切系统在乳腺良恶性疾病中的应用

为探讨B超引导下Mammotome微创旋切系统对乳腺良、恶性病灶的诊断与治疗的应用价值,对121例144处乳腺病灶进行了B超引导下Mammotome微创旋切术,评价其对乳腺病灶的诊治效果。121例144处乳腺病灶均被Mammotome微创旋切切除,平均旋切15次,用时30min,术后病检良性104例,其中乳腺纤维腺瘤78处,乳腺纤维腺病21处,乳腺囊性增生伴大导管扩张12处;恶性17例,其中肉瘤1例,原位癌2例,浸润癌14例。Mammotome切除标本冰冻切片检查的阴性预测值为98·1%(106/108),阳性预测值为了100·0%(15/15),1·5%的错误率。该方法伤口小、创伤小,除4例(3·3%)有轻度皮下瘀血外无其他并发症。初步研究结果提示,B超引导Mammotome微创旋切系统于乳腺良恶性疾病具有较高的诊断价值,可以替代常规手术作为乳腺良性肿瘤和可疑病灶的一种治疗方法。     

B超引导Mammotome微创旋切系统在乳腺良恶性疾病中的应用

为探讨B超引导下Mammotome微创旋切系统对乳腺良、恶性病灶的诊断与治疗的应用价值,对121例144处乳腺病灶进行了B超引导下Mammotome微创旋切术,评价其对乳腺病灶的诊治效果.121例144处乳腺病灶均被Mammotome微创旋切切除,平均旋切15次,用时30min,术后病检良性104例,其中乳腺纤维腺瘤78处,乳腺纤维腺病21处,乳腺囊性增生伴大导管扩张12处;恶性17例,其中肉瘤1例,原位癌2例,浸润癌14例.Mammotome切除标本冰冻切片检查的阴性预测值为98.1%（106/108）,阳性预测值为了100.0%（15/15）,1.5%的错误率.该方法伤口小、创伤小,除4例（3.3%）有轻度皮下瘀血外无其他并发症.初步研究结果提示,B超引导Mammotome微创旋切系统于乳腺良恶性疾病具有较高的诊断价值,可以替代常规手术作为乳腺良性肿瘤和可疑病灶的一种治疗方法.     

Cost-effectiveness of stereotactic large-core needle biopsy for nonpalpable breast lesions compared to open-breast biopsy

This paper demonstrates that the introduction of large-core needle biopsy (LCNB) replacing needle-localised breast biopsy (NLBB) for nonpalpable (screen-detected) breast lesions could result in substantial cost savings at the expense of a possible slight increase in breast cancer mortality. The cost-effectiveness of LCNB and NLBB was estimated using a microsimulation model. The sensitivity of LCNB (0.97) and resource use and costs of LCNB and NLBB were derived from a multicentre consecutive cohort study among 973 women who consented in getting LCNB and NLBB, if LCNB was negative. Sensitivity analyses were performed. Replacing NLBB with LCNB would result in approximately six more breast cancer deaths per year (in a target population of 2.1 million women), or in 1000 extra life-years lost from breast cancer (effect over 100 years). The total costs of management of breast cancer (3% discounted) are estimated at pound 4676 million with NLBB; introducing LCNB would save pound 13 million. The incremental cost-effectiveness ratio of continued NLBB vs LCNB would be pound 12 482 per additional life-year gained (3% discounted); incremental costs range from pound -21 687 (low threshold for breast biopsy) to pound 74 378 (high sensitivity of LCNB).     

超声导向活检在可疑小乳腺癌中的诊断应用

为了探讨超声引导粗针穿刺活检(ultrasound-guided core-needle biopsy,US-CNB)在可疑小乳腺癌(<2cm)肿块诊断中的实用价值及其影响因素,对50例可疑为乳腺癌的小肿块行超声引导粗针穿刺活检,其病理诊断结果与手术切除活检病理诊断结果进行对照。结果超声引导50个病灶中45个为恶性,5个为良性,术后活检证实2个假阴性,穿刺活检诊断阳性率为95.7%。初步研究结果提示,US-CNB是一种安全、准确、微创的操作,其诊断阳性率与穿刺针数、病变大小、病变组织类型等密切相关,诊断后应强调对良性病例进行随访。     

临床未扪及肿块的乳腺病灶穿刺活检现状

对于影像学诊断发现的临床摸不到块的乳腺病灶 ,可以采用B超或者X线立体定位下进行活检。细针吸取细胞学检查 (FNA)和空心针穿刺活检 (CNB)是目前最常用的两种穿刺活检诊断方法。对于乳腺X线异常的病灶 ,X线立体定位穿刺活检不仅诊断敏感性高 ,而且可以使大量良性病变免于不必要的手术 ;另外它还有助于手术方案的制定。由于存在组织学低估以及漏检等情况 ,穿刺活检尚不能完全取代手术活检。因此 ,必须合理地选择穿刺对象及掌握再次活检的指征     

前哨淋巴结活检在乳腺癌病人中的应用

目的 探讨前哨淋巴结（sentined lymph node，SLN）定位和活检（SLNB）及其对预测乳腺癌腋窝淋巴结（axillary lymph node，ALN）转移的准确性。方法 对本院自2004年6月至2006年6月收治的56例乳腺癌病人进行回顾，56例病人临床分期均为TmNoMo，术中在肿瘤周围或活检腔的正常乳腺组织皮下注射美蓝，进行SLN定位和活检。结果 SLNB的检出成功率为91．07％（51／56），准确性为92．16％（47／51），灵敏度为94．12％（32／34），假阴性率为5．88％（2／34），特异性为89．47％（17／19）。结论 用美蓝作SLN定位进行SLNB能准确预测乳腺癌腋窝淋巴结（ALN）转移状态。     

乳腺小肿瘤超声引导下活检研究进展

超声引导下活检凭借诸多优势对乳腺小肿瘤及可疑淋巴结的诊断日趋成熟。如何提高其诊断成功率及进行诊断后随访值得关注,同时要认识目前尚有争议的问题及这项技术的局限性,并研究其相关措施。目前在乳腺小肿瘤的临床诊疗中已出现了多种联合应用的新技术。     

Non-axillary breast cancer recurrences after sentinel node biopsy

BACKGROUND AND OBJECTIVES: The primary lymphatic pathway of patients with breast cancer is toward the axilla, but lymph drainage is also possible towards the internal mammary chain and the supraclavicular fossa. In the current article, the development of breast cancer recurrences at these two sites after sentinel lymph node biopsy is reviewed. METHODS: Since 1997, 803 patients underwent sentinel lymph node biopsy with intratumoral injection of 99mTc-nanocolloid and patent blue dye in The Netherlands Cancer Institute. All sentinel nodes as visualized on the lymphoscintigraphy images were pursued. The patients were followed prospectively for a median period of 34 months. Patients with a lymph node recurrence outside the axilla were identified and their lymphatic mapping procedures were reviewed. RESULTS: Four of the 803 patients (0.5%) developed regional lymph node recurrences outside the axilla. One recurrence was located in the internal mammary chain, the other three in the supraclavicular bed. One or two of these patients also had an axillary recurrence. The sentinel node procedure had failed in two of the four patients. CONCLUSION: The incidence of nodal recurrences outside the axilla is low. Although all extra-axillary sentinel nodes were pursued, some of these recurrences concern missed sentinel nodes that harbor metastasis. Identification of all sentinel nodes and subsequent treatment of the involved basins may reduce the risk of breast cancer recurrences in these unusual locations.     

超声引导下Mammotome旋切系统在诊断临床不可触及乳腺病灶应用研究

目的 探讨超声引导下应用Mammotome旋切系统,在临床不可触及乳腺病灶的诊断应用价值.方法 2004年6月～2004年9月,采用11 G自动活检刀头对123例265处＜15 mm临床不可触及的乳腺病灶进行B超引导下Mammotome微创旋切术,评价其对临床不可触及乳腺病灶的诊断效果.结果265个乳腺病灶大小3 mm～15 mm(平均9.1 mm),均被Mammotome微创旋切切除.结果术后病理诊断阳性31个病灶(包括不典型增生ADH,原位癌DCIS,LCIS,浸润癌).234个病灶为良性病变.术后B超随防3个月～6个月,未发现乳腺残留病灶.结论应用B超引导下Mammotome旋切系统对临床不可触及乳腺病灶可进行完整切除并获得明确病理组织学诊断,若为良性可获得理想美容学效果,若为恶性可使患者获得早期治疗,提高生存期.