摘要
目的探讨超声引导下空芯针穿刺活检(ultrasound guided-core needle biopsy,US-CNB)在直径0.6~1 cm乳腺结节中的诊断价值。方法回顾性分析我科2016年9月~2018年12月272例287个直径≥0.6 cm且≤1 cm的乳腺结节采用14G穿刺活检枪行US-CNB的结果。与手术切除病理或随访时间≥1年的结果比较,计算US-CNB诊断乳腺小结节的准确性。结果US-CNB均顺利完成。87个病灶行手术切除,穿刺与手术病理的总体一致率为81.6%(71/87)(κ=0.684,P=0.000),具有较好的一致性。穿刺病理为良性病变251个(87.5%,251/287),其中手术切除56个,术后病理良性病变44个,非典型增生12个,无恶性病变。穿刺病理为非典型增生14个(4.9%,14/287),其中手术切除9个,术后病理非典型增生6个,恶性病变3个;拒绝手术5个。127个穿刺为良性病变、4个穿刺为非典型增生病变随访时间≥1年,乳腺彩超提示病变稳定(病变BI-RADS分类未提高)。结合随访及手术结果,对1 cm以内乳腺结节,US-CNB诊断良性或非典型增生时漏诊恶性病变比例分别为0(0/183)、23.1%(3/13)。穿刺病理为恶性病变22个(7.7%,22/287),均手术切除,病理提示浸润性癌20个,原位癌1个,复杂硬化性腺病伴非典型增生1个,阳性预测值95.5%(21/22)。结论对于直径0.6~1 cm的乳腺病变,US-CNB可获得准确的诊断信息。对于穿刺病理结果为良性、影像学具有恶性特征的病变,建议进一步行手术切除活检;穿刺病理为非典型增生时,应手术切除活检,以避免遗漏恶性病变。
Objective To discuss the diagnostic value of ultrasound guided-core needle biopsy(US-CNB)for breast nodules with a diameter of 0.6-1 cm.Methods We retrospectively analyzed the pathology results of 287 breast nodules from 272 patients by 14G gun,with a diameter of 0.6 cm to 1 cm,in our hospital between September 2016 and December 2018.The results were compared with surgical excision or imaging outcomes followed up for a minimum of 1 year.The accuracy of US-CNB in the diagnosis of small lesions was evaluated.Results All the cases successfully underwent the process of US-CNB.A total of 87 nodules underwent surgical treatment.The overall consistency rate was 81.6%(71/87)(κ=0.684,P=0.000),showing a relatively high consistency.US-CNB identified 251 benign lesions(87.5%,251/287),and 56 lesions of them were resected.The surgical results of the 56 lesions mentioned above were 44 for benign lesions,12 for atypical hyperplasia and no for malignant lesion.US-CNB identified 14(4.9%,14/287)atypical hyperplasia,9 of which accepted the operation while 5 denied.According to surgical results,6 were atypical hyperplasia and 3 were malignant.A total of 127 benign lesions and 4 atypical hyperplasia were followed up by imaging for more than 1 year,indicating a stable condition without elevation of BI-RADS category by ultrasound.Combined with follow-up and surgical results,the proportion of malignant lesions missed by CNB was 0(0/183)and 23.1%(3/13)for benign lesions and atypical hyperplasia within 1 cm respectively.A total of 22(7.7%,22/287)malignant lesions identified by US-CNB were resected and the excision results showed 20 invasive carcinomas,1 carcinoma in situ and 1 complicated sclerosing adenosis with atypical hyperplasia.The positive predictive value of US-CNB was 95.5%(21/22)for malignant tumors.Conclusions For breast lesions with a diameter of 0.6 to 1 cm,US-CNB can obtain accurate diagnostic information.Further surgery is recommended for lesions with benign biopsy results but malignant features on imaging.For atypical hype
作者
张春
禹雪
张永辉
付芬芬
张冬洁
谢凌铎
褚福涛
栗辰
王芹芹
徐硕
解云涛
Zhang Chun;Yu Xue;Zhang Yonghui(Department of Breast Surgery,Peking University International Hospital,Beijing 102206,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2019年第10期915-918,共4页
Chinese Journal of Minimally Invasive Surgery
