超声引导真空辅助活检对乳腺癌诊断价值的研究

目的探讨超声引导真空辅助活检（VAB）对乳腺癌的诊断价值。方法回顾性分析接受术前超声引导VAB的825例乳腺癌的临床资料。结果817例VAB病理与术后病理诊断一致，8例组织学低估（0．96％）。与术后肿瘤标本对比，36例乳腺癌VAB取材标本ER、HER-2检测的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为91．4％、86．7％、95．0％、92．9％、90．5％，88．6％、87．5％、90．9％、95．5％和76．9％。12例超声提示良性病变且肿瘤〈2cm的患者接受肿瘤VAB切除术，VAB病理示浸润性癌，均行进一步手术治疗，术后病理示3例活检残腔未见残留癌，9例残腔见癌成分及不典型增生。结论VAB对乳腺癌患者术前提供明确病理诊断，为进一步手术、新辅助化疗提供诊断依据，同时VAB获得的肿瘤组织可行相关预后及预测指标检测。但VAB无法做到对“小乳腺癌”的完全切除，接受 保乳手术的患者仍然需要接受进一步扩大切除，保证切缘阴性。

Study of ultrasound-guided vacuum-assisted biopsy for the diagnosis of breast cancer

Objective To evaluate roles of ultrasound-guided vacuum-assisted biopsy (VAB) for the diagnosis of breast cancer. Methods A database containing 825 breast cancer patients who received VAB from Jan. 2004 to Sep. 2009 was retrospectively studied. Results Of the 825 patients, 817 patients had the same VAB pathology with the final pathology, while 8 were underestimated (0.96%). Compared to the final surgical specimen, the accuracy, sensitivity, specificity, positive predictive value and negative predictive value for the ER expressions by the tissue taken by VAB were 91.4%, 86.7%, 95.0%, 92.9% and 90.5%, respectively, and 88.6%, 87.5%, 90.9%, 95.5% and 76.9%, respectively for HER-2 . 12 patients were considered of having benign tumors (not larger than 2 cm) by ultrasound, and they received VAB resections with the VAB pathology of invasive breast cancer. After a further surgery, 9 had carcinoma or atypical hyperplasia tissues in the residual cavity, while 3 not. Conclusions VAB was a safe, accurate, and minimally invasive method for the histological diagnosis of breast cancer patients before further surgery and neoadjuvant chemotherapy, and it could provide same prognosis and predictive information for the patients. However, VAB could not suitable for the resection of "small breast cancer" and those who received breast conserving therapy still need further resection.