三维数字断层引导下立体定位活检技术对隐匿性乳腺病变的应用价值

The Applicational Value of Three-Dimensional Digital Breast Tomosynthesis Guided Stereotactic Needle Localized Biopsy of Nonpalpable Breast Lesions

目的探讨三维数字断层X线断层摄影(DBT)引导下对临床不能触及的乳腺隐匿性病变进行穿刺定位活检诊断的准确性及其临床应用价值,以确定恶性肿瘤的阳性预测值。方法连续性搜集190例隐匿性乳腺病灶患者,观察病变乳腺X线摄影表现及位置,经DBT引导下进行立体定位活检,定位后4小时接受手术。根据病理结果,统计活检取得的阳性率,并对活检病理结果与最终手术病理结果符合程度进行统计学分析。结果190例患者乳腺经乳腺X线摄影检查共发现246个病灶,术后病理结果其中有113个为恶性病灶,恶性病灶检出率为45.9%(113/246)。X线诊断准确性、敏感性及特异性分别为84.5%、81.6%及86.9%;246个病灶定位成功率96.7%(238/246),穿刺活检结果与术后切除活检病理诊断符合率为100%。结论三维DBT引导下定位活检技术对隐匿性乳腺病变定位准确,活检阳性率高,安全易行,在临床表现不明确的早期乳腺癌的术前诊断中起着重要的作用。

Objective To evaluate the accuracy and clinical value of stereotactic needle localized biopsy by three-dimensional X-ray digital breast tomosynthesis in the diagnosis of non-palpable breast lesions diseases,to determine the posi-tive predictive value for malignancy.Methods From January 2016 to January 2019,190 patients with occult breast lesions were continuously collected In Jiangsu Provincial Cancer Hospital,and clinically all of the cases were non-palpable breast lesions.The mammographic appearance and location of the lesions were observed,then core needle puncture biopsy were performed under the guidance of DBT.All the patients received surgery in 4 hours after the biopsy.According to the histopathological results,the succeeding,positive,pathological types were accounted.The pathological results of aspiration biopsy were collated with the final pathological results of surgeries.Results A total of 246 lesions were diagnosed by mammography in 190 patients.Of the 246 lesions,113 were malignant.The detection rate of malignant lesions was 45.9%(113/246).The diagnostic accuracy,sensitivity,specificity by DBT were 84.5%,81.6%and 86.9%,respectively.No obvious deviation was found.The succeeding rate of puncture biopsy of 246 lesions was 96.7%(238/246).The coincidence rate between puncture biopsy and pathological diagnosis of resection biopsy was 100%.Conclusion DBT-guided threedimensional stereotactic needle localized biopsy is an accurate and feasible method,which has high positive rate and plays an important role in the diagnosis of non-palpable breast lesions with inconspicuous symptoms.