乳腺立体定位核芯针活检的病理组织学低估原因分析

The histological underestimation of stereotactic core needle biopsy in breast lesions

目的分析乳腺立体定位核芯针活检的病理组织学低估的原因，以期引起临床多学科的重视及客观对待。方法2000年9月至2005年9月，对146例乳腺病变患者（179个病变）进行立体定位核芯针病变部位穿刺活检，发生病理组织学低估21个。病变均不可触及（NPBL），根据乳腺影像报告和数据系统（BI-RADS），活检前诊断BI-RADSⅢ类6个，Ⅳ类12个，Ⅴ类3个，影像表现为钙化16个，肿块2个，不对称性致密1个，星芒征2个。结果活检为纤维囊性乳腺病并导管上皮不典型增生11个，手术诊断为导管原位癌7个，伴早期浸润4个；活检为重度乳腺导管不典型增生3个，手术诊断为原位癌1个，原位癌伴早期浸润2个；活检为乳腺导管原位癌3个，手术证实均为浸润性癌；活检为乳头状病变4个，手术证实为原位癌及伴早期浸润各1个、浸润性导管癌及乳腺导管内乳头状腺癌各1个。结论乳腺核芯针活检的病理组织学低估与立体定位技术、病变本身及医师的认识有关，放射科医师应熟练掌握活检技术并力求全面取材，当穿刺活检结果与影像表现不符时，应重新评价病变的实际病理诊断。

Objective To analyze the histological underestimation of stereotactic core needle biopsy （SNCB）, and to attract clinicians＇ attention. Methods SNCB was performed in 146 patients with 179 lesions from September 2000 to June 2005, and 21 lesions were underestimated histologically. Of 21 nonpalpable breast lesions （ NPBL）, 6 lesions were diagnosed as BI-RADS m, 12 as BI-RADS IV, 3 as BI-RADS V according to BI-RADS before biopsy. Mammography showed 16 lesions with calicification, 2 cases with masses, 1 case with asymmetry density and 2 cases with stellate sign. Results Eleven lesions diagnosed as fibrocystic disease with atypical ductal hyperplasia by biopsy were proved to be ductal carcinoma in situ （DCIS） in 7 lesions and early infiltration in 4 lesions by pathology. 3 lesions diagnosed as severe atypical hyperplasia by biopsy were finally proved to be 1 carcinoma in situ and early infiltration in 2 lesions by pathology. 3 lesions diagnosed as DCIS by biopsy were invasive carcinoma. 4 lesions diagnosed papillary lesions by biopsy and finally were 1 carcinoma in situ, 1 early infiltration, 1 infiltrating ductal carcinoma and 1 intraductal papillary adenocarcinoma. Conclusion The histological underestimation of SCNB was related to the stereotactic location technology, lesion and doctor＇s understanding, the radiologist should master the biopsy skills.