数字乳腺X线导丝定位技术在不可触及乳腺病变的应用

Application of Stereotactic Needle Localized Biopsy Guided by Digital Mammography in Non-palpable Breast Lesions

目的:探讨数字乳腺X线导丝定位技术引导手术切除不可触及的乳腺病变(NPBL)的临床应用价值。方法:回顾分析40例临床触诊阴性,而行数字乳腺X线摄影(DM)显示成簇细小钙化、模糊小结节及局部结构紊乱等病灶的女性患者临床资料,行计算机立体定位,置留导丝于可疑病灶处,引导手术切除,标本经照像证实,病变切除后送检病理科,根据病理结果制定进-步治疗方案。结果:40例患者行DM发现病灶41个,置留导丝4l根,导丝引导手术活检41次。X线表现:成簇或不规则钙化33个(80.5%),局部结构紊乱1个(2.4%),肿物7个(17.1%)。病理结果:恶性病变16个(39.0%),其中导管内癌13个(31.7%),浸润性导管癌3个(7.3%),行乳腺癌根治性手术;良性病变25个(61.0%),包括纤维腺瘤6个(14.6%),导管内乳头状瘤2个(4.9%),乳腺增生病17个(41.5%)。定位切除成功率为100%。结论:DM引导导丝定位活检技术,对不可触及的乳腺病变可准确定位,解决了外科医生盲目手术切除的困难,还可以明确病变的良恶性,对提高早期乳腺癌诊断具有重要意义。

Objective： To evaluate the value of stereotactic needle localized biopsy guided by digital mammography in non-palpable breast lesions. Methods： Retrospective analysis was conducted in 40 cases of non-palpable breast lesions with malignant signs such as clusters of calcification, poorly-demarcated nodules or regional structural irregularities in the digital mammography. After computerized stereotactic puncture of the lesions was done, a guide wire was indwelled in the suspected spot. With the guidance of the wire, surgical resection of the suspected tissue was performed. In order to confirm whether the lesions were completely removed, the patients underwent mammography after surgical resection. Pathological diagnosis of the removed tissue was obtained. Results： Digital mammography showed 41 lesions in these 40 patients and 41 wires were indwelled to guide the surgical biopsy. Thirty-three cases had cluster or irregular calcification （ 80.5% ）, one case had partial structural disorder （ 2.4% ） and 7 cases had masses （ 17.1% ）. Pathological examination showed breast carcinoma in 16 cases （ 39.0% ）, including 13 cases of intraductal carcinoma （ 31.7% ） and 3 cases of invasive ductal carcinoma （ 7.3% ）; benign lesions in 25 cases （ 61.0% ）, including 6 cases of fibroadenoma （ 14.6% ）, 2 cases of intraductal papillary carcinoma （ 4.9% ）, and 17 cases of hyperplasia （ 41.5% ）. The detection rate of breast carcinoma was 39.0%. The lesions were 100% removed by wire location guided resection. Conclusion： Surgical biopsy with the guidance of indwelling wire placed through stereotactic puncture guided by digital mammography is helpful in correctly localizing and removing small latent breast lesions. It can solve the surgical difficulties due to blind resection, and can help to confirm the diagnosis of the lesions, indicating its significant value in detecting early breast carcinoma.