超声引导下麦默通微创旋切系统切除乳腺良性病变

目的探讨超声引导下麦默通微创旋切系统切除乳腺良性病变的应用价值。方法经临床和超声诊断良性病变51例患者进行超声引导下麦默通微创旋切术。结果51例患者中49例完全切除,2例患者一个月后随访,发现少量残留。除术中少量出血2例,术后少量出血1例外,无其它并发症。病理1例为导管内癌,其余均为良性病变。结论超声引导下麦默通微创旋切系统切除乳腺良性病变,具有微创、切除肿块完整、并发症少的优点,有较高的应用价值。     

超声引导下Mammotome微创旋切系统在乳腺良性病变切除术中的应用

目的探讨超声引导下Marnmotome微创旋切系统往切除乳腺良性病变中的应州价值。方法86例乳腺肿瘤患者,115个乳腺肿块,经超声或X线钼靶检查,结合临床初步诊断为良性病变,在超声引导下应用Mammotome微创旋切系统治疗,同时行病理检查。结果乳腺病灶在超声引导下均被完全切除,每个肿块手术时间（20±10）min,平均旋切次数15次,皮肤切口0．25～0．4cm。1例出现切口下血肿,2个月后完全吸收,5例出现皮下淤血癍,术见感染．结论超声引导下Mammotome微创旋切乳腺良性病变,具有创伤小、并发症少、恢复快、乳房表面不留疤痕等优点,是一种值得推广的乳腺病变微创治疗方法。     

超声引导下经皮细针穿刺活检诊断胰腺病变

目的 探讨超声引导下经皮细针穿刺活检诊断胰腺病变的临床应用价值。方法 选取本院胰腺病变患者104例,均于超声引导下用20 G自动切割针行经皮穿刺活检。104例患者中16例以手术后病理做最终诊断,88例以活检病理结合影像学检查及随访结果做最终诊断。评价穿刺活检取材满意率,诊断符合率及术后并发症情况。结果 104例患者中胰腺局灶性病变97例(97/104,93.27%),其中实性病变84例(84/97, 86.60%),囊实性病变13例(13/97,13.40%),弥漫性病变7例(7/97,6.73%)。104例患者共接受112次穿刺活检,97次取材满意并得到病理诊断,其中实性病变取材满意率(89/97,91.75%)高于囊实性病变(8/15,53.33%),优势比为9.973。97例取材满意标本中得到的病理诊断与最终诊断相符者89例,8例诊断不相符者均误诊为胰腺炎。活检诊断的准确率、敏感度、特异度分别为91.75%(89/97)、90.12%(73/81)、100%(16/16)。患者活检后7例发生并发症,均为轻-中度腹痛,无严重并发症发生。结论 超声引导下经皮细针穿刺活检胰腺病变安全、有效,其对胰腺实性病变取材满意率优于囊实性病变。     

超声引导下Mammotome活检系统在乳腺微小病变中的应用

目的 探讨超声引导下Mammotome活检系统在乳腺微小病变(小于1cm)中的诊断和治疗价值.方法 超声引导下Maxrmaotome活检系统对小于1cm的34个病灶行乳腺肿块微创旋切术,并评价该系统在乳腺微小病变中的应用价值.结果 术后病理学诊断纤维腺瘤26个,乳管内乳头状瘤4个,浸润性导管癌、腺癌、原位癌、乳腺病各1个,病理结果阳性率100%,超声均能清晰显示微小肿块微创旋切的全过程.结论 超声引导下Mammotome活检系统对于临床难以发现的小于1 cm的微小病灶可以明确地进行病理学诊断和显示微创完整切除,能提高乳腺恶性肿瘤的早期检出率,是一种值得推广的微创手术方法.     

超声引导下经皮穿刺活检诊断胰腺实性病变

目的 观察超声引导下经皮穿刺活检诊断胰腺实性病变的效能,探讨诊断准确率影响因素。方法 回顾性分析746例因胰腺实性病变接受经皮超声引导下粗针穿刺活检(US-CNB)患者,记录临床及影像学资料、胰腺穿刺相关资料和病理诊断;以穿刺12个月后临床随访结果为最终诊断,评估US-CNB诊断胰腺实性病变的效能。以单因素分析及logistic回归 分析筛选影响US-CNB诊断准确率的因素。结果 742穿刺活检成功,技术成功率99.46%(742/746)。US-CNB准确诊断706例(准确组)、不准确36例(不准确组),其诊断胰腺实性病变的敏感度、特异度、准确率、阳性预测值及阴性预测值分别为95.25%(702/737)、80.00%(4/5)、95.15%(706/742)、99.86%(702/703)和10.26%(4/39)。31例(31/742,4.18%)发生轻度并发症,4例(4/742,0.54%)发生严重并发症。组间患者年龄,胰腺病灶最大径＜2 cm、病灶边界不清晰及病灶位于胰头部占比差异均有统计学意义(P均＜0.1)。回归分析显示,病灶最大径＜2 cm是US-CNB诊断准确率的独立影响因素(OR=3.054,P=0.030)。结论 超声引导下经皮胰腺病变穿刺活检安全、可靠,但病灶体积小可能影响其准确性。     

Complete extirpation of benign breast lesions with an ultrasound-guided vacuum biopsy system.

OBJECTIVES: To investigate whether ultrasound-guided vacuum biopsy (VB) with curative intent is suitable for the complete extirpation of selected sonographically detectable benign lesions of the breast, and to establish the limitations of the method with regard to lesion size and complications, the extent of scar formation and the prognostic value. METHODS: One hundred and nine patients underwent hand-held, ultrasound-guided VB (8G or 11G needle) between June 2000 and September 2003. Of these, 45 (41%) women underwent ultrasound-guided extirpation of 46 lesions, and 42 women with 43 lesions were followed up clinically and sonographically for an average of 5.9 months. The complete extirpation rate, residual lesions, and patient satisfaction with the intervention were evaluated. RESULTS: Removal of all sonographic evidence of lesions (median diameter, 13 mm) was achieved in 86% of cases (8G needle, 80%; 11G needle, 89%). 19% of the patients had suspected scar formation at the biopsy site. A palpable lesion in the breast could be removed by VB in 90% of cases. None of the patients developed infections and there were no hemorrhages requiring intervention, or damage to the skin or chest wall. A total of 95% of the patients stated that they would prefer this approach to open excision for possible future intervention. CONCLUSIONS: VB is an ambulatory procedure associated with a low degree of pain. It has a high degree of patient acceptance and, as a minimally invasive biopsy technique for benign lesions, is a good alternative to open excision. The rate of complications is low and is similar to that observed with conventional microbiopsy.     

Ultrasound-guided biopsy of palpable breast masses

Objective: Breast ultrasound and US-guided interventional procedures of the breast are increasingly being applied and integrated in the diagnostic work-up and management of breast patients. The aim of the study was to assess the reliability of ultrasound-guided (US-guided) needle core biopsy of palpable breast masses with a 1.2 mm needle (18 gauge) in a fully automated firing device as an alternative to the existing surgical routine, i.e. surgical excision or palpation-guided Tru-Cut biopsy with a 2.0 mm needle (14 gauge) in a semi-automated device. Method: US-guided biopsy of palpable breast masses was prospectively, consecutively and openly compared to open surgical biopsy in a design closely connected to the routine diagnostic work-up of these patients. Results: 106 Patients with a palpable mass in one of their breasts were included in this study. The final diagnosis was the histological result of the open surgical biopsies, which were: 49 malignant lesions, 14 fibroadenomas, and 43 cases of fibrocystic disease. Forty-six malignant tumors were detectable ultrasonically and US-guided biopsy was performed, yielding adequate and correctly positive diagnoses in 41 cases (89%). Three US-guided samples were adequate for diagnosis but yielded a false-negative result. Two samples were excessively fragmented and thus inadequate for diagnosis. All 14 fibroadenomas were correctly diagnosed ultrasonically and US-guided sampling yielded a correct diagnosis in all but one case which was inadequate. The remaining 43 cases showed no abnormality on the sonogram and open biopsy yielded fibrocystic disease. Conclusion: US-guided biopsy of palpable breast masses can obviate open surgical biopsy whenever a mass is ultrasonically visible and it is strongly advocated to implement the procedure in the diagnostic work-up of these patients.     

超声引导下经皮穿刺活检在肺周围型小病变中的应用

目的评价超声引导下穿刺切割活检在直径〈2cm的肺周围型病变中的诊断正确性和安全性。方法35例患者肺周围型病变患者（直径〈2cm）,选用18G或16G穿刺活检针行超声引导下切割活检,标本送组织病理检查,结果与手术病理及临床随访的最后诊断进行比较。结果35例患者,组织取材满意率为94％（33／35）;明确诊断为86％（30／35）;其中恶性病变91％（20／22）,良性病变77％（10／13）;穿刺后并发症其5例,气胸2例,咯血3例。结论超声引导下对肺周围型病变切割活检是一种安全、有效．且诊断正确性高的方法．即使在较小病变（直径〈2cm）中,也能取得较好效果。     

超声引导下活检诊断晚期卵巢癌的临床价值

目的 探讨超声引导下穿刺活检诊断晚期卵巢癌的临床应用价值。 方法 对102例怀疑晚期卵巢癌患者行超声引导下穿刺活检,并将结果与术后病理进行比较分析。结果 穿刺取材满意率93.68%（163/174）,活检成功率91.18%（93/102）。根据卵巢病灶最大径分为3组：>5.0 cm组36例、1.5~5.0 cm组50例、<1.5 cm组16例,三组穿刺诊断准确率分别为94.44%（34/36）、98.00%（49/50）、62.50（10/16）,三组间差异有统计学意义（P<0.05）;<1.5 cm组中采用腹膜活检、卵巢联合腹膜活检者的诊断准确率高于单独卵巢肿物活检者,差异具有统计学意义（P=0.029）。结论 对可疑晚期卵巢癌患者行超声引导下穿刺活检,对于晚期卵巢癌及某些特殊病例的确诊与治疗具有重要的临床意义。     

超声引导麦默通在乳腺肿块微创旋切术中的应用

目的探讨超声引导下麦默通在乳腺肿块切除中的应用价值。方法56例经临床结合超声诊断的乳腺肿块,女性患者,在超声引导下使用麦默通行乳腺肿块微创旋切术。结果56例患者共旋切148个肿块,直径5～30min,超声均能清晰显示肿块微创旋切的全过程。术中监测和术后复查有2例2个结节未被完整切除,完整切除率98．6％。56例患者病理结果阳性率100％。结论超声引导麦默通对乳腺肿块微创旋切具有定位切除准确、病理诊断率高、创伤小、疗效好、操作简单、安全等优点,尤其适合于30mm以下的乳腺良性肿块,是一种值得推广的微创手术方法。     

Minimal invasive complete excision of benign breast tumors using a three-dimensional ultrasound-guided mammotome vacuum device.

OBJECTIVE: The aim of this study was to evaluate the use of three-dimensional (3D) ultrasonography in the complete excision of benign breast tumors using ultrasound-guided vacuum-assisted core-needle biopsy (Mammotome). A protocol for the management of benign breast tumors is proposed. METHOD: Twenty consecutive patients with sonographically benign breast lesions underwent 3D ultrasound-guided mammotome biopsy under local anesthesia. The indication for surgical biopsy was a solid lesion with benign characteristics on both two-dimensional (2D) and 3D ultrasound imaging, increasing in size over time or causing pain or irritation. Preoperatively, the size of the lesion was assessed using 2D and 3D volumetry. During vacuum biopsy the needle was visualized sonographically in all three dimensions, including the coronal plane. Excisional biopsy was considered complete when no residual tumor tissue could be seen sonographically. Ultrasonographic follow-up examinations were performed on the following day and 3-6 months later to assess residual tissue and scarring. RESULTS: All lesions were histologically benign. Follow-up examinations revealed complete excision of all lesions of < 1.5 mL in volume as assessed by 3D volumetry. 3D ultrasonographic volume assessment was more accurate than 2D using the ellipsoid formula or assessment of the maximum diameter for the prediction of complete excision of the tumor. No bleeding or infections occurred postoperatively and no scarring was seen ultrasonographically on follow-up examinations. CONCLUSIONS: Ultrasound-guided vacuum-assisted biopsy allows complete excision of benign breast lesions that are 相似文献   

真空辅助活检系统在乳腺病灶诊治中的研究进展

真空辅助活检(VAB)系统设计的初衷是对乳腺病灶进行穿刺活检,其是在细针抽吸细胞学检查(FNAC)和空芯针活检(CNB)的基础上发展而来的。与后两者相比,其取材量更加充足,诊断准确率更高,但在临床应用中由于存在针道种植转移的潜在危险和价格相对昂贵等原因,目前在单纯乳腺疾病的诊断性穿刺领域应用不如CNB那样广泛。但在乳腺良性肿瘤的治疗方面,VAB系统能在影像学监视下对较小的瘤体完全切除,与外科手术治疗相比创伤小、并发症少,并能满足患者美容方面的需求,越来越受临床医师和患者的青睐。另外,VAB系统用于治疗男性乳房异常发育症及乳腺脓肿已初步开展且疗效确切。     

粗针穿刺活检乳腺非恶性增生病变的病理诊断

在影像指导下的粗针穿刺活检现已越来越多地取代外科手术切开活检 ,作为对乳腺病变的初始组织病理学检查的方法。此法快速、方便 ,比针吸活检 (FNA)更准确 ,比外科手术活检创伤要小、更经济。但是 ,因为采样限制 ,病理医师在对这类标本做诊断时应当慎重。目前的研究认为如果在切针刺活检标本中检及乳腺导管不典型增生或原位癌、小叶不典型增生或原位癌、乳头状病变、放射性瘢痕、富于细胞纤维上皮瘤和分叶状肿瘤、柱状上皮和黏液囊样病变时 ,应建议做手术切开活检 ,以减少浸润性癌的漏诊。此外 ,每周影像学、病理学讨论相关病例是质量保证的重要措施之一。对病理学—影像学诊断不相符合的病例也应建议做手术切除活检。     

超声引导下Mammotome微创旋切术在乳腺肿瘤中的应用

目的探讨超声引导下Mammotome微创旋切术在乳腺肿瘤中的应用价值。方法对196例285个乳腺肿瘤进行超声引导下Mammotome微创旋切术。结果 285个乳腺肿瘤均被超声引导下Mammotome微创旋切术完全切除,每个肿瘤平均旋切13次(5～28次),手术时间30min(15～60min)。2例患者术后并发皮下血肿,余无并发症。手术瘢痕长2.5～5.0mm且较隐蔽。术中冰冻切片报告乳腺纤维瘤175例,乳腺腺病12例,导管内乳头状瘤6例,导管内原位癌3例。196例均应用超声检查进行术后随访,均未提示局部复发。结论应用Mammotome微创旋切系统切除适当大小乳腺肿瘤,可完全切除肿瘤并明显减少术后瘢痕,达到美容美观效果,并发症少,且可早期诊断可疑恶性肿瘤。     

超声引导下穿刺活检在乳腺非肿块样病变诊断中的应用价值

目的探讨超声引导下穿刺活检在乳腺非肿块样病变中的诊断价值。 方法选取2017年1月至2018年12月杭州市第一人民医院超声科经超声检查评估为乳腺影像报告与数据系统（BI-RADS）4a类及以上的乳腺非肿块样病变患者93例,共计93个病灶。所有病变均行超声引导下穿刺活检,并经手术病理证实。应用四格表计算超声引导下穿刺活检对乳腺非肿块样病变的诊断效能。 结果手术病理结果提示,恶性病灶47个,良性病灶46个。超声引导下穿刺活检结果提示恶性病灶43个,良性50个。穿刺活检漏诊4个恶性病灶,术前超声均提示为BI-RADS 4b,术后病理证实3例为导管原位癌和1例为浸润癌。超声引导下穿刺活检诊断乳腺非肿块样病变的敏感度为91.4%（43/47）,特异度为100.0%（46/46）,假阴性率为8.6%（4/47）,诊断准确性为95.7%（89/93）。 结论超声引导下穿刺活检对乳腺非肿块样病变的诊断存在一定的假阴性率,但敏感度、特异度及准确性均较高,具有良好的诊断价值。     

高频超声引导麦默通微创旋切术在乳腺疾病中的应用

目的 探讨高频超声引导麦默通(Mammotome)微创旋切术在治疗乳腺疾病中的应用价值。方法 2008年1月至2010年10月对经高频超声诊断的320例患者412个乳腺病灶在高频超声引导下进行Mammotome微创旋切术治疗,所有标本送病理检查,术后3～6个月进行超声随访。结果 320例患者412个乳腺病灶在高频超声引导下均被成功切除。术后病理显示409个良性病灶,3个恶性病灶,诊断符合率97.6%。术后5例出现局部血肿,3例皮下淤血,4例乳腺囊肿患者术后复发。结论 高频超声引导Mammotome微创旋切术对治疗乳腺良性疾病有重要价值,值得推广。     

Sonographically guided needle biopsy of nonpalpable breast lesions.

This article describes the techniques of sonographically guided fine-needle aspiration (FNA) and core-needle biopsy (CNB) of nonpalpable breast lesions. Virtually any nonpalpable breast lesion that is clearly demonstrated on sonograms can be sampled with a needle under ultrasound guidance. Advantages of ultrasound-guided FNA include its pinpoint accuracy, the excellent tolerance by patients, and the ability to aspirate or inject fluid or air. Advantages of ultrasound-guided CNB include a near 100% tissue recovery rate even in fibrous masses, the ability to assess the invasiveness of a cancer, and the fact that tissue cores are readily interpreted by any pathologist. In institutions in which an expert cytopathologist is available, FNA is often used as a first-line biopsy technique, with CNB being reserved for situations in which FNA cannot provide a definitive answer to the question asked. In most institutions, however, CNB has become the standard for percutaneous needle biopsy of breast masses, and sonography has replaced stereotaxy as the standard guidance technique for nonpalpable masses.     

Needle-localized biopsy of occult breast lesions

Over a 3 1/2-year period, we did 121 needle-localized breast biopsies for nonpalpable, mammographically suggestive lesions. The presence of a mass lesion on mammography with or without microcalcifications was associated with malignancy more frequently than microcalcifications alone. In 15 cases (12.4%), biopsy showed malignancy; 13 patients had modified radical mastectomy, with 11 (85%) having no histologic evidence of axillary metastases. Evaluation of risk factors associated with breast cancer in those patients with positive biopsy results showed that advanced age and a past history of a breast cancer were present in a significant number of patients. Four patients (3.5%) had complications; a hematoma developed in one (0.8%), and three (2.7%) required a second biopsy to remove the suggestive mammographic lesion. We conclude that needle-localized breast biopsy is a reliable tool in detecting early breast carcinoma. The procedure causes only minimal morbidity and we believe it should be done in all patients with mammographically suggestive, nonpalpable breast lesions.