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。

Significance of Mammograpphic Imaging-guided Stereotactic Localization in the Treatment of Breast Micro-lesions

Objective To evaluate mammographic imaging--guided stereotactic localization with colour marker and to detect suspicious of breast lesions and microcalcifications previous to open surgical biopsy (OSB). Methods 153 patients with highly suspicious radiologic lesions and microcalcifications underwent mammographic imaging--guided stereotactic localization with colour marker to be followed by OSB. All patients were female. The mean age was 51.5 years (range: 34--71 years old). There were 93 cases of microcalcifications and 60 cases of suspicious spiculated masses or areas of architectural distortion to be confirmed by mammography. If the lesions were considered benign, they were followed--up. If the lesions was malignant, they were treated. Results In 153 lesions, there were 113 malignant lesions. There were 62 cases (40.5 % ) of invasive ductal and lobular carcinoma, 23 cases (15 %) of carcinoma in situ (CIS), 21 cases (13.7 %) of comedocarcinoma, 4 cases (2.7 %) of cribriform carcinoma, 3 cases (2%) of micropapillary carcinoma, and 40 cases (26.1%) of benign lesions. Among 40 patients with benign lesions, there were 13 cases of atypical ductal hyperplasia. 112 cases (73.2%) underwent complete surgical excision which turned out to those negative margins. conclusion Mammographic imaging--guided stereotactic localization with colour marker, previous to open surgical biopsy of supicious breast lesions and microcalcifications is an effective and accurate measure. It is an integrated part of the routine diagnosis or pre--surgical work--up in patients with nonpalpable suspicious breast lesions.