X线立体定位真空辅助空芯针活检术在诊断乳腺微小钙化病变中的作用

目的:评价应用11G活检针行X线立体定位真空辅助空芯针活检术(stereotractic vacuum-assisted biopsy,SVAB)在诊断乳腺微小钙化病变中的作用.方法:采用11G活检针对93例乳腺钼靶X线检测提示存在微小钙化病灶的患者实施SVAB检测,对病理结果为恶性或者不典型乳腺增生或不能明确诊断的病例以及钼靶X线摄影诊断结果与活检病理明显不符的患者均实施开放手术.比较术后的病理结果和活检病理结果.结果:在97例次微小钙化病变中,通过SVAB共有96例次(99.0％)成功获得钙化组织；活检病理结果显示,71例次(73.2％)为良性病变,19例次(19.6％)为恶性病变,6例次(6.2％)为不典型增生.有25例患者最终行开放性手术,2例次(2/13,15.4％)导管原位癌最终诊断为浸润性癌,1例次(1/4,25.0％)导管不典型增生最终诊断为导管原位癌,1例钼靶影像与活检病理不符患者最终诊断为导管原位癌.71例病理诊断为良性的患者中有49例中位随访时间达14.5个月,均未发现明显异常.并发症包括血管迷走反应(1.0％)、出血(2.1％)和血肿形成(3.1％).结论:SVAB对诊断乳腺微小钙化病变是可靠而有效的方法,其不良反应较小,但需要准确掌握适应证；对影像学-组织学诊断不一致、病理诊断为不典型增生或导管原位癌可能存在组织学低估的病例,需要实施进一步的手术活检.

Value of an stereotactic vacuum-assisted biopsy for the diagnosis of breast microcalcifications

Objective:To evaluate the value of an 11-gauge stereotactic vacuum-assisted biopsy(SVAB) device for the diagnosis of breast microcalcifications.Methods:The 11-gauge SVAB was performed in 93 patients with microcalcifications in X-ray mammograms.The patients who were diagnosed as having breast cancer,atypical hyperplasia,unclarified breast lesions and imaging-histologic discordance should require surgical excision.The histopathological results of biopsy specimens and postoperative specimens were compared.Results:Of 97 lesions with microcalcifications,96(99.0%) calcified tissues were obtained.The pathological results showed that 71(73.2%) were benign lesions,19(19.6%) were malignant lesions,6(6.2%) were atypical hyperplasia lesions.Of the 25 patients receiving surgical excision,2(2/13,15.4%) with ductal cancer in situ had a final diagnosis of invasive breast cancer,1(1/4,25.0%) with atypical hyperplasia lesions had a final diagnosis of ductal cancer in situ,1 with imaging-histologic discordance had a final diagnosis of ductal cancer in situ.Of 71 patiens with a pathological diagnosis of benign lesions,49 had a median follow-up of 14.5 months,and no obvious abnormalities were observed.The complications of 11-gauge SVAB included vasovagal reactions(1.0%),bleeding(2.1%) and hematoma formation(3.1%).Conclusion:The 11-gauge SVAB is an effective and reliable method with slight side effects for the diagnosis of breast microcalcifications if it is applied appropriately.For the breast lesions diagnosed as having atypical hyperplasia and ductal carcinoma in situ or with imaging-histologic discordance,the surgical biopsy should be performed subsequently.