超声引导乳腺肿物穿刺活检导致病理组织学诊断低估的原因分析

Histopathological underestimation of breast nodules in ultrasound guided large-core needle biopsy

目的探讨超声引导乳腺肿物粗针穿刺活检术(US-LCNB)导致病理组织学低估的原因。方法对拟行手术的271例乳腺肿瘤患者术前行US-LCNB,将术前粗针活检病理结果与手术切除肿瘤标本病理诊断结果进行比较,分析18G和16G粗针术前活检所致的病理组织学低估及误诊原因。结果术前对271例乳腺肿物行US-LCNB301次,术前穿刺活检诊断与病理诊断符合率为85.7%(258/301),病理组织学低估32次(10.6%),误诊11次(3.7%)。其中应用18G针穿刺活检32次,术前活检与术后病理诊断符合24例(75.0%),穿刺活检所致病理低估7次(21.9%),误诊1次(3.1%);应用16G针穿刺活检269次,术前活检与术后病理诊断符合234例(87.0%),穿刺活检所致病理低估25次(9.3%),误诊10次(3.7%)。因乳腺肿瘤组织成分呈多样性、穿刺取样局限或穿刺者对病灶定位不精准是US-LCNB所致病理组织学诊断低估的原因。结论术前US-LCNB所致的病理组织学诊断低估是肿瘤组织成分多样性和穿刺取样偏倚造成,并与穿刺活检获得的组织量少相关,可通过增加穿刺次数、应用较粗的活检针穿刺取样以获取满足病理诊断的组织量,降低US-LCNB所致的组织学诊断低估率。

Objective To analyze the reasons of histopathological underestimation of breast nodules in ultrasound-guided large-core needle biopsy. Methods Two hundreds and seventy one cases of breast nodules were involved in this study and received operations to remove breast nodules. Before operations, all cases received ultrasound-guided large-core needle biopsy. Compared histopathology diagnosis of operations with needle biopsies, diagnostic accurate rate, false-negative rate and underestimate rate of disease were recorded. Results Three hundred and one times of needle biopsy were performed in 271 cases of breast lesions. Patients who received biopsy in 16G and 18G needle were 269 and 32, respectively. Histological examinations were finished in all cases. The diagnostic accurate rate of 16G needle was 87.0% （234/269）, rate of understimaton was 9.3% （25/269） and false-negative rate was 3.7% （10/269）. 18G needle was 75.0% （24/32）, 21.9% （7/32） and 3.1% （1/32）, respectively. The differences of tumor framework, limited biopsy sample, target locating and puncture technique of operator were reasons of histopathological underestimation in ultrasound-guided large-core needle biopsy. Conclusions The differences of tumor framework and limited biopsy sample were main reasons of histopathological underestimation in ultrasoundguided large-core needle biopsy in breast lesions, and biopsy tissue dose was correlated with histopathological underestimation. Increasing puncture frequency and using large-core needle can decrease false-negative rate and underestimate rate of disease.