立体定位法对乳腺微小病灶的治疗意义

目的介绍钼靶片引导下立体穿刺定位,美蓝标记加小手术活检方法。方法153例乳腺微小病变患者接受术前钼靶片引导下立体穿刺定位,美蓝标记加手术活检。其中93例微小钙化,60例可疑肿块和局部结构紊乱。将标本进行钼靶摄片,确认病灶取下。如病理结果为良性病灶,则随访。如为恶性病灶,则作进一步处理。结果153例中,恶性病灶113例(73．9％),其中浸润性导管癌和小叶癌62例(40．5％),原位癌23例(15％),粉刺样癌21例(13．7％),筛状癌4例(2．7％),粉刺样癌21例(13．7％),筛状癌4例(2．7％),微小乳头状癌3例(2％);良性病灶40例(26．1％),其中13例是非典型导管增生。112例(73．2％)手术完全切除,切缘阴性。结论钼靶片引导下立体穿刺定位,美蓝标记乳腺可疑病灶和微小钙化加手术活检方法是一种有效而安全的方法。对于无肿块型可疑病灶,该方法可作为常规检查。     

X线立体定位活检诊断乳腺微小病变

目的：评价X线立体定位活检对乳腺微小病变的诊断价值。方法：采用计算机辅助三维立体定位系统、弹射式活检枪和16G活检针，对31例X线发现的乳腺可疑病变灶直接立体定位穿刺活检。其中24例随后行外科手术，穿刺活检与手术活检的病理结果对照。结果：24例中乳腺癌8例（33．39／5），良性病变16例（66．79／5），诊断符合率为87．5％，误诊3例（12．5％）。结论：X线立体定位活检是鉴别乳腺微小病变良恶性的有效方法，有助于早期发现乳腺癌。     

超声引导下导丝定位在切除不可触及乳腺病变中的应用

目的:比较超声引导乳腺病灶表面皮肤标记定位和超声引导下导丝定位两种定位方法在超声可及、临床不可及乳腺病灶切除术中的作用.方法:分析超声引导乳腺病灶表面皮肤标记定位和超声引导下导丝定位乳腺病灶后行开放手术切除病人的临床资料,比较其在定位率、定位时间、手术时间、标本重量、切除组织量/病灶组织量比值、手术标本切缘及并发症等方面的差异.结果:两组在病灶定位成功率上没有差别.超声引导乳腺病灶表面皮肤标记定位组定位时间(7 min)较超声引导下导丝定位组(18 min)明显缩短(P＜0.01),但在手术时间上相反,前者需35 min,后者为23min(P＜0.01),手术切除标本重量前者(65 g)大于后者(43 g)(P＜0.01),切除组织量/病灶组织量比值前者(150)亦大于后者(67)(P＜0.01).手术切缘阳性率及并发症发生率没有差别.结论:超声引导下导丝定位准确率高、可缩短手术时间,避免切除过多正常乳腺组织从而减少对乳腺外形的影响,是超声引导乳腺病灶表面皮肤标记定位方法较好的替代.     

钼靶下导丝定位活检在诊断触诊阴性乳腺病灶中的应用

目的：探讨钼靶下导丝定位活检技术对触诊阴性乳腺可疑病灶的诊断价值。方法：选取52例钼靶检查发现可疑病变而临床触诊阴性、彩超无特异发现的乳腺病灶进行钼靶下导丝定位后手术活检并送病理检查。结果：52例患者行钼靶引导下导丝定位均一次操作成功,术后病理报告：恶性病变16例,其中浸润性导管癌7例,导管原位癌6例,导管内癌早期浸润2例,浸润性小叶癌1例;良性病变36例,其中乳腺增生症15例,纤维腺瘤7例,轻～中度非典型增生5例,炎症性病变4例,导管内乳头状瘤3例,乳腺导管扩张症2例。乳腺癌检出率为30．8％,诊断准确率为100％。结论：钼靶下导丝定位乳腺活检定位准确,安全可行,可有效提高不可触及的乳腺病变切除活检的精确性,利于早期乳腺癌的发现。     

临床不可触及乳腺病变超声引导下空芯针穿刺活检的临床应用

目的评价超声引导空芯针穿刺活检（US-CNB）在临床不可触及乳腺病变术前诊断中的应用价值。方法收集行超声引导空芯针穿刺活检的临床不可触及的乳腺病变患者46例,结合手术后病理切片,对空芯针穿刺活检标本和开放性活检（EP）标本的病理组织学诊断进行比较和分析。结果 46例患者经US-CNB诊断为乳腺腺病32例,纤维腺瘤8例,导管上皮增生4例,导管上皮不典型增生1例,导管内癌1例,导管内癌伴早期浸润1例。22例未做手术,随访至今无疾病进展。24例行开放性活检手术,US-CNB与开放性活检的病理诊断符合率为91.7%,kappa=0.921（P〈0.01）.US-CNB病理诊断的敏感性为95.8%,特异性为100%,假阴性4.16%,无假阳性。结论对于临床不可触及肿块的乳腺病变,超声引导下空芯针穿刺病理学检查是可靠的诊断方法,US-CNB诊断为非肿瘤性病变的患者可免于开放性手术,长期随访。     

Use of a specimen-evaluation device for the diagnosis of impalpable breast lesions detected by mammography.

OBJECTIVE: To describe a method for accurate excision and exact histopathological diagnosis of impalpable breast lesions, considered suspicious of carcinoma, and detected on mammographic examination alone. SETTING, PATIENTS AND INTERVENTIONS: Eight-five patients referred with a suspicious but impalpable mammographic lesion underwent preoperative radiological localisation followed by surgical excision biopsy. Specimen radiology with a radiolucent acrylic compression-grid specimen-evaluation device confirmed that the lesion had been excised. By use of the grid coordinates, exact histopathological examination of the radiological area of suspicion was carried out to provide a definitive pathological diagnosis. RESULTS: Twenty-eight patients (33%) were found to have invasive carcinoma or extensive intraduct breast carcinoma requiring further surgical and adjuvant management. Nineteen of these patients (68%) had no axillary node metastases. CONCLUSION: The use of an acrylic compression-grid specimen-evaluation device in the diagnosis of suspicious mammographic breast lesions facilitates confirmation of excision by specimen radiology, and expedites accurate histological examination of suspicious radiological lesions.     

乳腺小肿瘤活检方法的进展

目的：对乳腺小肿瘤活检方法进行比较。方法：就术前着色定位法、经皮核芯活检、针刺定位下乳腺切开活检、Mammotome活检及旋切系统（Mammotome vacuum assisted biopsy device and a stereotactic unit,MMT）对乳腺肿块进行微创切除在乳腺小肿瘤活检中的研究进展进行综述。结果：MMT技术是一种安全、准确和有效的根治乳腺良性肿块的微创技术,值得推广和应用。结论：对于一些可疑恶变的小肿块,准确无误的切除并准确取样送病检非常重要。     

Mammtome术诊断乳腺隐匿性病灶和不典型增生

目的探讨Mammtome术对乳腺隐匿性病灶的诊断,及对Mammotome术检出不典型增生的外科治疗策略.方法2003.3～2004.3月对该院14例共16处乳腺隐匿性病灶行超声引导下Mammotome微创旋切术,12例行起声引导下穿刺活检.结果Mammotome术检出14例16处乳腺隐匿性病灶中,5例非典型增生(31.3%),1例乳腺癌(6%);5例非典型增生中2例重度的和1例轻度的非典型增生接受手术,结果证实为重度的和轻度非典型增生,符合率100%.余2例中-轻度非典型增生未手术,给予他莫昔芬口服,随访无复发.12例行超声引导下穿刺活检中非典型增生1例(8.3%),再次手术结果为乳腺癌.结论Mammotome术利于乳腺隐匿性病灶的诊断.对Manmotome术检出不可触及肿块的重度非典型病灶,建议再次手术切除;对中度以下的非典型增生,在超声证实肿块已全切情况下,可避免再次手术,予他莫昔芬口服并随访.     

Prebiopsy localisation of impalpable breast lesions

Prebiopsy localization of impalpable breast lesions (IBL) assures removal of suspicious mammographically detected lesions. Specimen radiograph of the excised specimen is mandatory to confirm complete excision. The aim of this study was to audit our series of percutaneous hookwire localization and to determine the positive biopsy rate of the mammographically detected impalpable breast lesion in our center. Thirty-eight patients with suspicious IBL underwent excision biopsy under mammographic localization in our unit from late February 1998 to May 2003. The excised specimen is immobilized and compressed within the Transpec device. This device incorporates a reference grid visible in the specimen radiograph. Hence, the target lesion marked in the reference grid of the specimen radiograph will allow precise examination and exact localization of the suspicious lesion by the pathologist. The positive biopsy rate for malignant lesion was 26.3%, the majority fall in the range of 40-59 age group. Thirty-two (84.2%) of the patients had clustered micro-calcifications, 4 (10.5%) had impalpable mass lesions and in 2 (5.3%) spiculated lesions were seen on the preoperative mammogram. Mammographic feature of clustered micro-calcification accounts for all the malignant lesions in our series. Utilization of Transpec device has shown to be practical, reliable and cost effective in the management of IBL. Nonetheless, it should be emphasized that optimal specimen radiography and pathological correlation requires close cooperation between radiologist, surgeon and pathologist.     

超声引导美兰染色切除不可触及乳腺病变的研究

目的:比较超声引导美兰染色手术方案相对于超声引导细针穿刺定位以及豪洛杰微创旋切手术方案切除不可触及乳腺病变(NPBL)的优势和不足,综合评估超声引导美兰染色切除NPBL的临床应用价值。方法：本研究将入组的120例NPBL患者分成三组,分别采用超声引导美兰染色(美兰组)、超声引导细针穿刺(定位针组)以及豪洛杰微创旋切(旋切组)手术方案进行手术治疗,统计各手术方式组的手术时间,出血量,切口长度,疼痛评分,术后并发症,住院费用,住院天数,肿块病理等数据结果,并在术后随访12个月,观察比较各组患者伤口愈合情况,有无局部残留、复发等情况。结果：相较于穿刺针定位和旋切术式,美兰染色手术法所用的手术时间更短、住院费用更低(P<0.001),术中出血较少,术中、术后疼痛均耐受,良性病例均当日出院,无切口感染、血肿等并发症发生,术后随访无复发,恶性病变病人无转移。结论：超声引导美兰染色切除不可触及乳腺病变的手术方式操作简单,手术时间短,住院费用低,近期及远期并发症少,对于基层医疗机构具有临床推广价值。     

乳腺X线立体定位活检术的临床应用

探讨应用乳腺钼靶机及配套的立体定位装置，对无临床体征而乳腺摄片有异常征象，即不可触及的乳腺微小病变（NPBL）患者，导入特制的钢丝定位针进行手术切除（NLOB）的价值。回顾性总结分析对32例NPBL的患者进行的NLOB。结果发现：32例患者中，11恶性病变，21例为良性病变，需要手术的共有15例，占47％。提示NLOB解决了对NP活检的难题，该方法对NPBL的定性、定位诊断准确、安全、实用。     

临床触诊阴性乳腺病变术前超声引导色素标记定位

目的:评价临床触诊阴性乳腺病变术前超声引导定位的意义。方法:54例女性患者,年龄31~77岁的66个临床触诊阴性乳腺病变在超声引导下对病变表面注入无害色素进行标记,并行切除术。结果:66个乳腺病变经术前超声引导定位后全部被准确切除,7例(10.61%)为恶性肿瘤。结论:临床触诊阴性的乳腺病变经超声引导下色素标记定位是一种微创、简便、实用方法,易于推广。     

NPBL的X线表现及SCNB、SNLB的临床应用

目的分析临床触诊阴性，X线片上发现可疑改变，但不能定性的乳腺隐匿性病灶（Nonpalpable breast lesion NPBL）的X线表现。探讨X线立体定位核芯针活检术（Stereotactic needle core biopsv，SCNB）、X线立体定位细针定位活栓术（Stereotactic mammography needle localized biopsy，SNLB）活检NPBL的临床应用价值。方法回顾性分析96例NPBL的X线表现，其中59例行SCNB，37例行SNBL，将X线表现与病理结果进行对照。结果96例NPBL在X线片上表现为细沙样簇状钙化47例，孤立结节21例，局限性致密或结构紊乱18例。放射状毛刺影10例。行SCNB活检的病例，良性病变43例、恶性病变16例；行SNLB活检的病例，良性病变26例、恶性病变11例。结论准确识别X片上的NPBL，针对性地合理使用SCNB及SNLB，可提高早期乳腺癌的检出率及减低良性病变的手术活检率。     

Outpatient needle localization and biopsy for nonpalpable breast lesions

We reviewed 101 consecutive biopsy specimens of nonpalpable breast lesions obtained by needle localization. Forty-six biopsies were done on outpatients under local anesthesia and 16 more on inpatients under local anesthesia. The remaining 39 biopsies were performed on inpatients under general anesthesia. The complications and accuracy of the outpatient procedure were acceptable and comparable to those of the inpatient procedure. In our institution, there is almost a fivefold cost increase for the performance of this procedure under general anesthesia as an inpatient. We recommend that surgeons and radiologists work together to perfect preoperative localization techniques, and we strongly support the concept that this procedure should be performed on outpatients under local anesthesia for the majority of patients with nonpalpable mammographic abnormalities.     

The biopsy of nonpalpable breast lesions detected on mammography

This is a review of the positive biopsy rate of nonpalpable breast lesions detected on mammography. The histology of 130 hookwire excision biopsy from 1990 to 1995 and the cytology of 39 stereotactic fine needle aspiration cytology in 1995 were reviewed. The yearly positive biopsy rate of each procedure was determined. In 1990, the positive biopsy rate for hookwire excision biopsy was 15%, in 1991 20%, in 1992 11%, in 1993 17%, in 1994 33% and in 1995 39%. In 1995, the positive biopsy rate for stereotactic fine needle aspiration cytology was 21%. The positive biopsy rate for hookwire excision biopsy had improved from 15% in 1990 to 39% in 1995.     

超声引导穿刺活检与钩针定位手术活检诊断乳腺隐匿性病变

目的探讨超声引导下穿刺活检与钩针定位手术活检对乳腺隐匿性病灶的诊断价值。方法将临床触诊阴性而超声显示乳腺可疑肿块病灶经随机单盲法分为A组和B组。A组进行超声引导粗针穿刺活检;B组行超声引导钩针定位手术活检。术前均进行常规彩色多普勒超声检查。结果 A组55个隐匿性病灶中,恶性病灶13个,良性病灶42个,穿刺准确率96%;B组47个隐匿性病灶中,恶性病灶11个,良性病灶36个,定位准确率98%。结论超声引导下粗针穿刺活检和钩针定位手术活检均是诊断早期乳腺癌的有效方法。穿刺活检简便易行、无疤痕,是诊断乳腺隐匿性病变的首选方法。     

65例乳腺隐匿性病灶的诊断与治疗体会

目的探讨乳腺X线、超声立体定位细针活检技术对不可能触及的乳腺灶的诊断价值。方法对65例临床未触及乳腺病变（notaetic mammograpy needle localized biopsy, SNLB）,行超声立体定位活检,并进行组织病理学检查。结果65例乳腺病变中,恶性病变42例（64．6％）,其中导管内癌12例,浸润性导管癌16例,单纯癌9例,髓样癌3例,大汗腺癌2例;良性病变23例（35．4％）,其中乳腺导管内乳头状瘤8例,乳腺非典型增生8例,乳腺小叶增生7例。结论立体定位细针活检对不可触及的乳腺病变的定位定性诊断以及对早期乳腺癌诊断有重要价值。     

钼靶立体穿刺定位活检对无体征乳腺癌的诊疗价值

目的:探讨乳腺钼靶立体穿刺标记定位活检在临床触诊阴性乳腺癌中的诊断及治疗价值。方法:对35例钼靶X片上有可疑病灶而无任何临床体征的患者,在X线立体定位下穿刺病灶并用金属导丝标记,标记后根据导丝位置切除病灶,并进行快速冰冻活检,明确诊断后采取不同手术方式治疗。结果:35例中12例(34.0%)为乳腺癌,均行改良根治术;23例(66.0%)为良性。冰冻切片病理检查与术后石蜡报告结果一致。结论:乳腺钼靶立体穿刺标记定位活检技术对临床触诊阴性的早期乳腺癌诊断方法准确、可靠,值得临床推广应用。     

超声在早期触诊阴性乳腺癌术中定位的应用

目的：总结利用超声对早期乳腺癌行术中定位的应用与体会。方法：回顾性分析2002年1月～2010年1月我院57例临床触诊阴性的乳腺癌患者,行决定性手术之前利用术中超声对病灶进行定位,并用蓝染或金属导丝对病灶进行标记。结果：利用术中超声可正确地对乳腺癌病变进行定位切除,其中浸润癌占97%（55/57）,复切率为7%（4/57）,在所有患者中切缘阴性率为88%（50/57）,其中大部分切缘阳性的患者是无钙化的原位导管癌或浸润性导管癌伴广泛原位导管癌,只有5%的患者为多中心性浸润癌,并对其实施乳腺切除术。结论：对于临床触诊阴性的乳腺癌患者若需影像辅助术中定位病变时,超声应为首选方法之一。     

99mTc-MDP核素显像诊断乳腺肿瘤的临床价值

目的 寻找有效和无创性诊断乳腺癌的方法。方法 对可触及的７５例乳腺肿瘤进行了＾９９ｍＴｃ－ＭＤＰ显像,将其结果与乳腺Ｘ线摄像和Ｂ超对比分析,全部肿瘤经病理或细胞学证实。结果 ７５例乳腺肿瘤中５０例为乳腺癌,２５例为良性肿瘤。＾９９ｍＴｃ－ＭＤＰ显像诊断乳腺肿瘤假阳性５例,假阴性５例,其灵敏度为９０％（４５／５０）,特异性为８０％（２０／２５）,准确性为８７％（６５／７５）;６２例乳腺肿瘤行Ｘ线摄像