乳腺隐匿性病灶定位穿刺切除技术及应用

The technique and application of local resection of nonpalpable mammary lesions with the guidance of indwelling wire placed in by puncture

目的:探讨临床触诊阴性而乳腺影像检查阳性的隐匿性乳腺病变行定位穿刺留置导丝引导手术切除活检的技术操作及应用价值。方法:临床触诊阴性,而乳腺X线或CT摄片显示成簇的细小钙化、模糊小结节及局部结构紊乱等微小病灶,通过穿刺留置导丝于可疑的病灶区,然后手术切取活体组织行病理学检查。结果:38例45处病灶均一次性定位成功,未发生出血、导丝脱出等并发症。X线钼靶定位穿刺25处病灶,其中小结节边界模糊致密灶3处,成簇或较集中的微小钙化灶21处,局部结构紊乱1处。CT定位穿刺20处病灶,其中小结节边界模糊致密灶15处,微小钙化灶4处,局部结构紊乱1处。病理结果:恶性病变3例3处病灶,癌前病变4例6处,良性病变31例36处。结论:立体定位穿刺留置导丝引导手术活检术对乳腺隐匿性病变定位准确,不仅能使手术精确切除乳腺微小病灶,又能有效减少腺体损伤,是早期发现乳腺癌的有效途径。

Objective. To summarize the procedure and clinical value of the application of local resection with the guidance of preoperation indwelling wire placed through puncture under X-ray or CT scan in treatment of nonpalpable but mammography or CT demonstrated small breast lesions. Methods： Operation of local resection was done in patients with suspected small lesions founded by mammography or CT scan, which cannot palpable clinically, demonstrated signs such as clusters of microcalcifications, small nodules or regional structural irregularities. After puncture under X-ray or CT of the lesion was done, a guide wire was indwelled in the suspected spot. With the guidance of the wire, surgical resection of the suspected tissue was made. Results： 45 lesions of 38 patients were punctured successfully only one time. 25 lesions were found and punctured under X-ray, including clusters of microcalcifications （21 lesions）, small nodules （3 lesions） and regional structural irregularities （lleslon）. 20 lesions were found and punctured under CT, including clusters of microcalcifications （15 lesions）, small nodules（4 lesions） and regional structural irregularities （1 lesion）. Pathological results showed malignant in 3 lesions （3 patients）, precancerous change 6 lesions（4 patients） and benign in 36 lesions（31 patients）. Conclusion： Surgical resection with the guidance of indwelling wire placed through puncture is very helpful in correctly localizing and removing small latent breast lesions. The technique is a reliable and useful approach to surgical practice with less invasive and easy performing, and is very helpful for the diagnosis of breast lesions.