术中标本摄片用于乳腺可疑钙化病变组织活检

目的 观察术中标本摄片用于乳腺可疑钙化病变组织活检的价值。方法 对48例乳腺单发可疑钙化病变患者行X线三维立体定位引导活检术，对其中12例行核芯针穿刺活检(SCNB)、22例行真空辅助旋切活检(SVAB)、14例行导丝定位手术切检(SNLB),术中以标本摄影系统对组织标本行X线摄片，之后对标本中的钙化进行标记并送病理检查；评估标本摄片在3种活检方式中显示钙化的清晰度及组织学低估情况，观察SNLB术中标本摄片所示钙化数目及切缘状态，并与术前乳腺X线片进行比较。结果 所有标本均获得目标钙化组织。术中标本摄片显示钙化清晰度优于术前乳腺X线片，显示SNLB组织内钙化数量多于术前乳腺X线片。14例SNLB中，12个术中标本摄片显示切缘阴性，与术后病理结果一致；2个切缘阳性，且钙化呈多灶性分布，术中快速冰冻切片结果均为恶性并切缘阳性，手术计划由保乳手术改为乳腺癌改良根治术。SCNB、SVAB活检结果及SNLB术中冰冻切片结果与手术病理结果均一致。结论 术中标本摄片用于乳腺可疑钙化病变组织活检具有一定价值。

Intraoperative specimen mammography in biopsy of suspicious breast calcification lesions

Objective To explore the application value of intraoperative specimen mammography in biopsy of suspicious breast calcification lesions. Methods Totally 48 patients with suspicious breast single calcification lesion underwent X-ray three-dimensional stereotactic guided-biopsy, including 12 cases of stereotactic core needle biopsy (SCNB), 22 cases of stereotactic vacuum-assisted biopsy (SVAB) and 14 cases of stereotactic needle localized biopsy (SNLB). Intraoperative mammography of all the specimen performed with specimen mammography system, and the calcifications in the specimens were marked and sent for pathological examination. The clarity of calcification in intraoperative specimen mammography and pathological underestimation of the above 3 biopsy methods were assessed, the number of calcifications and lumpectomy margin status of SNLB specimen were observed and compared with preoperative mammography. Results The target calcifications were obtained in all specimens. The clarity of calcifications on intraoperative specimen mammography was superior to that of preoperative mammography, and there were more calcifications of SNLB specimen were observed than of preoperative mammograms. Among 14 cases of SNLB, intraoperative mammographic negative resection margin was detected in 12 cases being consistent with postoperative pathological results, while positive resection margins and multi-focal calcification was noticed in the remaining 2 cases and then confirmed by intraoperative rapid frozen pathology, and finally the planned breast-conserving surgery was modified as radical mastectomy. The pathological results of all SCNB, SVAB and SNLB rapid frozen pathology were consistent with those of the subsequent surgery. Conclusion Intraoperative specimen mammography had certain value for biopsy of suspicious breast calcification lesion.