超声引导下Mammotome微创旋切系统在乳腺良性肿瘤治疗中的应用

目的 探讨超声引导下Mammotome微创旋切术在乳腺良性肿瘤中的诊治价值.方法 回顾性分析2006年10月至2009年3月我科238例乳腺肿瘤患者在高频超声引导下行Mammotome微创旋切术的临床资料,评价其在乳腺良性肿瘤治疗中的应用价值.结果 614个乳腺病灶绝大部分被切除,术后病理学诊断均为良性.术后血肿形成2例,皮下淤斑4例.术后6个月行超声复查,发现3例病灶残留.结论 超声引导下Mammotome微创旋切术是对直径小于2.5cm乳腺良性病灶的首选诊治方法,操作简单、安全,创伤小且病灶切除彻底.     

超声引导微创旋切术治疗乳腺肿瘤220例疗效分析

目的探讨超声引导下微创旋切系统在乳腺肿瘤诊断和治疗的临床应用及疗效分析。方法对两年多来经超声引导Mammotome微创旋切术治疗的乳腺肿瘤220例疗效进行回顾性分析。结果220例中共有病灶287个,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,术后1例局部复发、2例出现局部血肿。结论超声引导微创旋切术治疗乳腺肿瘤是一项创伤小、并发症少、安全有效的乳腺微创技术,对良性肿瘤能够完全切除。尤其受到年青女性患者的青睐。     

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。     

Mammotome真空辅助微创旋切系统在隐匿性乳腺病灶诊断中的应用

目的探讨超声引导下Mammotome真空辅助微创旋切术对隐匿性乳腺病灶诊断的意义。方法2003年11月至2005年1月对30例隐匿性乳腺病灶进行B超引导下Mammotome真空辅助微创旋切术。结果30例患者均无一例失败,术后均明确诊断,恢复良好。结论超声引导下Mammotome真空辅助微创旋切术有利于隐匿性乳腺病灶的诊断,手术创伤小,恢复快。对良性疾病兼具治疗作用。     

B超引导下乳腺微创旋切术治疗乳腺良性肿瘤40例

目的:探讨B超引导下ENCOR旋切术在乳腺良性疾病诊治中的应用价值。方法:应用微创旋切术对40例乳腺肿瘤患者进行诊断及治疗。结果:40例患者的75个乳腺肿块被准确、完全切除,术后病理学诊断均为良性,术后每3～6个月复查见切口小而隐蔽,瘢痕不明显,乳腺外形及皮肤感觉正常,超声未发现病灶残留、复发。结论:微创旋切术是治疗乳腺良性肿瘤的安全、高效、符合美学观点的治疗方法。     

麦默通旋切系统在临床触诊阴性乳腺病灶的应用

【摘要】〓目的〓探讨超声引导下麦默通旋切系统在临床触诊阴性乳腺病灶中的诊疗作用。 方法〓对62例共85个临床触诊阴性乳腺病灶进行超声引导下麦默通旋切术。结果〓85个病灶皆被准确、完整切除。术中冰冻切片病理示良性病变77例,乳腺癌8例。85例术中冰冻切片和术后石蜡切片诊断均相符。术后3个月复查B超均未见局部复发。结论〓超声引导下麦默通旋切术是确诊临床触诊阴性乳腺病灶的有效方法,在诊断的同时可完整切除良性病灶,达到治疗效果。     

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。     

高频超声引导下Mammotome微创旋切术在乳腺良性疾病中的应用

目的探讨高频超声引导下Mammotome微创旋切系统对乳腺良性疾病诊断和治疗的临床应用价值。方法分析高频超声引导下Mammotome微创旋切治疗40例64个临床诊断乳腺良性病灶的疗效，并记录术后病理结果及其随访情况。结果40例64个乳腺病灶被准确完全切除，切除组织足够用于病理诊断；其中35个病灶为纤维腺瘤，13个为乳腺腺病，11个为乳腺腺病伴纤维腺瘤形成，4个为乳腺囊肿，1个为导管上内乳头状瘤。1例术后出现局部血肿。结论Mammotome微创旋切术是一项创伤小、并发症少、安全有效的乳腺微创技术，对乳腺良性病灶能够进行完全切除。     

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。     

超声引导Mammotome微创旋切系统在多发乳腺肿物中的应用

目的探讨超声引导Mammotome微创旋切系统对乳腺多发肿物进行微创切除的治疗价值。方法 2005年10月～2009年10月,超声引导下对183例多发乳腺肿物的893个肿物进行Mammotome微创旋切手术。结果全部肿物均采用Mammotome微创旋切,术后病理诊断纤维腺瘤或纤维腺病伴腺瘤形成634个,纤维腺病189个,导管内乳头状瘤42个,硬化性腺病18个,乳腺囊肿6个,导管上皮不典型增生4个。术后并发症:血肿4例,皮下瘀斑25例,乳头溢血5例。术后随访3～48个月,其中1年74例,1～2年70例,2～3年27例,3～4年12例。切口小而隐蔽,乳房无变形,肿瘤残留7例(3.8%,5例为术后1年内出现,2例为术后1年半出现)。结论应用超声引导Mammotome旋切术切除乳腺多发病灶效果好,微创优势明显,操作简单、安全,值得推广。     

Mammotome微创旋切术切除乳腺肿块1081例分析

目的探讨超声引导下Mammotome微创旋切术治疗乳腺肿块的方法和效果。方法回顾性分析1081例、1913处乳腺肿块经超声引导下Mammotome微创旋切术治疗后的疗效和随访效果。结果对1081例患者、1913处肿块行Mammotome微创旋切切除术,每处病灶平均用时4分钟,平均旋切组织15次。1063例、1894处（99.01%）为乳腺良性病变,18例、19处（0.99%）为乳腺癌。共发生术中、术后并发症39处。结论Mammotome微创旋切系统是目前临床治疗乳腺良性肿块和诊断早期乳腺癌的有效方法之一。     

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.     

Evaluation of percutaneous vacuum assisted intact specimen breast biopsy device for ultrasound visualized breast lesions: Upstage rates and long term follow-up for high risk lesions and DCIS

ObjectivePercutaneous core biopsy of ultrasound visualized breast lesions is standard for diagnosis. Large gauge vacuum-assisted core needles have improved accuracy; but a significant underestimation of malignancy remains. The Intact^R device was assessed for upstaging and subsequent malignancy at the biopsy site.Methods469 consecutive ultrasound visualized breast lesions, < 2.0 cm in size, BIRADS 4 or 5, biopsied with Intact^R Breast Lesion Excision System, between July 2007 and August 2014, were reviewed. All non-concordant lesions (0.8%), DCIS (1.7%) and invasive cancers (9.8%) were surgically excised. Excision was recommended for all high risk lesions (13.0%). The upstage rate to DCIS or invasive cancer was determined. All patients were followed for a median of 66 months (24–96 months) with serial imaging and exams to determine the incidence of re-biopsy, or malignancy at the original biopsy site.Results23 of 61 high risk lesions (37.5%) were not excised, but observed for a median of 66 months. None required re-biopsy. One atypical lesion was upstaged to DCIS on excision. No patient was diagnosed with malignancy at or near the original biopsy site during follow-up. Overall upstage rate was 1.2%.ConclusionsPercutaneous biopsy of ultrasound visualized lesions was performed accurately using Intact^R. Upstaging was much lower with Intact^R than with large-gauge core needles. High risk lesions, diagnosed with Intact^R, have a very low upstage rate at surgical excision. It may be possible to observe these lesions without surgery when they present as ultrasound findings and undergo Intact^R biopsy.     

Clinically occult breast carcinoma: Diagnostic approaches and role of axillary node dissection

Background: Nonpalpable breast lesions are being detected with increasing frequency with the advent of improved mammographic techniques. Although only 20–30% of these lesions are malignant, definitive diagnosis has usually required a needle-localization excisional biopsy, which is costly and increases the psychological stress on the patient. The purpose of this retrospective study was to determine the sensitivity of ultrasound-guided fine-needle aspiration (FNA) biopsy of nonpalpable breast masses and the incidence of axillary nodal metastases in these subclinical lesions. Methods: Seventy-one patients treated for clinically occult malignant breast tumors between 1985 and 1992 were identified. Charts were reviewed to determine the accuracy of breast ultrasonography in detecting occult mass lesions and whether ultrasound guidance improved the accuracy of FNA biopsy. In addition, the incidence of axillary lymph node involvement was noted. Results: Of the 71 malignant tumors, 35 were in situ and 36 were invasive. The median diameter was 0.5 cm for noninvasive lesions and 0.8 cm for invasive tumors. A mass was seen on mammography in 32 (45%) patients, microcalcifications were seen in 36 (51%), and both a mass and microcalcifications were seen in three (4%). Of the 30 patients who underwent an axillary node dissection, 4 (13%) had disease-positive nodes. Ultrasound-guided FNA was performed in 15 patients with a mass lesion, with a sensitivity of 93%. Conclusions: These results indicate that ultrasound-guided FNA cytologic analysis is an accurate diagnostic technique even in small (<1 cm), mammographically detected breast masses. In addition, the incidence of axillary nodal metastases indicates that an axillary lymph node dissection should be performed in invasive lesions, even those <1 cm in diameter.     

Malignancy Rate and Malignancy Risk Assessment in Different Lesions of Uncertain Malignant Potential in the Breast (B3 Lesions): An Analysis of 192 Cases from a Single Institution

BackgroundThe question of how to deal with B3 lesions is of emerging interest.MethodsIn the breast diagnostics of 192 patients between 2009 and 2016, a minimally invasive biopsy revealed a B3 lesion with subsequent resection. This study investigates the malignancy rate of different B3 subgroups and the risk factors that play a role in obtaining a malignant finding.ResultsThe distribution of B3 lesions after minimally invasive biopsy was as follows: atypical ductal hyperplasia (ADH), 7.3%; flat epithelial atypia (FEA), 7.8%; lobular neoplasia (LN), 7.8%; papilloma (Pa), 49.5%; phylloidal tumour (PT), 8.9%; radial sclerosing scar (RS), 3.1%; mixed findings, 10.4%; and other B3 lesions, 5.2%. Most B3 lesions were detected by stereotactic vacuum-assisted biopsy (44.3%), 36.5% by ultrasound-assisted biopsy, and 19.3% by magnetic resonance imaging-assisted biopsy. Most B3 lesions (55.2%) were verified by surgical resection, whereas 30.7% were downgraded to a benign lesion. About 14.1% of the cases were upgraded to malignant lesions, 9.4% to ductal carcinoma in situ and 4.7% to invasive carcinoma. In relation to individual B3 lesions, the following malignancy rates were found: 28.6% (ADH), 13.3% (FEA), 33.3% (LN), 12.6% (Pa), 5.9% (PT), and 0% (RS). The most important risk factor was increasing age. Postmenopausal status was considered an increased risk for an upgrade (p = 0.015). A known malignancy in the ipsilateral breast was a significant risk factor for a malignant upgrade (p = 0.003).ConclusionIncreasing knowledge about B3 lesions allows us to develop a “lesion-specific” therapy approach in the heterogeneous group of B3 lesions, with follow-up imaging for some lesions with less malignant potential and concordance with imaging or further surgical resection in cases of disconcordance with imaging or higher malignant potential.     

乳腺良性病灶的微创手术

目的：探讨B超引导下Mammotome微创旋切系统对乳腺良性病灶的应用价值，及其与常规手术对比的优点。方法：将行B超引导下Mammotome微创旋切65例84处乳腺良性病灶与同期行常规门诊手术的482例535处乳腺良性病灶作对比，评价它们的诊治效果。结果：65例84处乳腺病灶均被Mammotome微创旋切术切除．平均旋切15次，用时26min；操作无一例失败。与常规门诊手术比较，这种方法皮肤伤口小，除6例有轻度皮下淤血外无其他并发症。结论：用B超引导下的Mammotome微创旋切术行乳腺纤维腺瘤微创切除，与常规门诊手术相比，其近、远期效果相同，但手术疤痕较小，减轻了病人的痛苦。     

One Hundred Consecutive Advanced Breast Biopsy Instrumentation Procedures: Complications, Costs, and Outcome

Background: Needle localization and excision have been the preferred techniques for treating nonpalpable mammographic abnormalities. Recently, a less invasive approach, using the Advanced Breast Biopsy Instrumentation (ABBI) system, was introduced. This study was undertaken to determine the feasibility, utility, and cost of this new alternative approach.Methods: Between April 1996 and May 1997, 100 consecutive women underwent excisional breast biopsies using the ABBI system. Demographic information, mammographic findings, pathological findings, hospital/professional fees, complications, and subsequent interventions were documented.Results: Excisional biopsies using the ABBI system were successful for 99 women (average age, 62 years; range, 34–87 years). Of the 99 lesions removed with the ABBI system, 27 were microcalcifications, 60 were suspicious solid nodules, and 12 were nodules with microcalcifications. The ABBI system was used in an outpatient surgical setting, with only one patient requiring sedation (because of anxiety). Cancer was seen in the biopsy specimens for 18 patients, seven of whom (35%) exhibited no residual tumor at the time of definitive treatment. Postoperative hematomas occurred in two patients; one hematoma required surgical drainage. One missed cancer was detected in follow-up mammograms 6 months after biopsy. The total average procedural cost was $3406.44 ± 486.63Conclusions: Excisional breast biopsy using the ABBI system is an effective diagnostic method. It has a low complication rate, and its cost is comparable to that of classical needle localization.     

Stereotactic core needle biopsy of mammographic breast lesions as a viable alternative to surgical biopsy

Background: Stereotactic needle biopsy technique has received considerable attention as a possible alternative to surgical biopsy of nonpalpable breast lesions. The exact role of this procedure in the management of mammographic breast lesions has not yet been accurately defined. Methods: Data have been collected prospectively on 416 patients over an 8-month period (January 1992 through August 1992). Of 416, 356 patients underwent only stereotactic breast biopsy with a 14-gauge needle. Sixty patients underwent stereotactic breast biopsy followed by surgical biopsy. Based on mammographic findings before biopsy, lesions were classified as benign (24%), likely benign (49%), malignant (2%), likely malignant (6%), and indeterminate (19%). The number of core biopsy specimens obtained from each patient ranged from one to six. Results: The specimen was considered adequate in 98% of cases. Complications were minimal. The tissue diagnosis was benign in 92% and malignant in 8% of patients. In those patients undergoing surgical and stereotactic biopsy, 57 of 60 had matching histopathological results, representing an agreement rate of 95% (p<0.001). The three patients whose histopathological results did not match had malignant diagnoses on stereotactic biopsy that were subsequently not identified in the modified radical mastectomy specimen because the entire focus of malignancy was removed by the several passes made by the core needle during biopsy. No patient had a negative stereotactic biopsy result in whom malignancy was later detected by surgical biopsy. Conclusions: This study indicates excellent agreement between surgical and stereotactic needle biopsy findings. Stereotactic biopsy with a 14-gauge needle could obviate the need for surgical biopsy in certain women with radiologically benign, likely benign, and indeterminate lesions. The results of this study were presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

Mammotome乳腺良性肿块微创旋切术的临床应用

目的探讨B超引导下Mammotome微创旋切系统在乳腺良性肿块切除中的临床应用价值。方法B超引导下应用Mammotome系统对98例296处乳房良性肿块施行微创旋切术。结果所有肿块均被准确、完全切除。每个肿块的切除时间平均为25（15～60）min，平均旋切次数20（8～32）次，皮肤切口0.2～0.3cm。未出现活动性出血、皮下淤血、感染等并发症。结论B超引导下Mammotome微创旋切系统切除乳房良性肿块，操作简单、准确、安全、创伤小，是一项值得推广的乳腺微创技术。