超声引导空芯针穿刺活检在乳腺肿物诊断中的应用

Ultrasound-guided Core Needle Breast Biopsy:Results of 170 Cases

目的探讨超声引导下14G空芯针穿刺组织活检在乳腺肿物诊断中的应用,并与手术病理结果相对照,确定其诊断的准确率,随访观察穿刺后近期及远期并发症。方法回顾性分析超声检查发现BI-RADS4b～4c乳腺肿物的患者170例,共173个乳腺肿物,均在超声引导下行乳腺肿物穿刺活检及病理学检查。所有肿物在穿刺结果回报后均接受外科手术切除。穿刺结果为浸润性乳腺癌则依据患者病情接受乳腺癌改良根治或保乳根治手术。穿刺结果为良性则行肿物切除术。最终均以外科手术切除后的病理结果为金标准。观察穿刺术后近期及远期并发症。结果穿刺活检病理报告浸润性乳腺癌的肿物141个(81.5%),其余32个肿物(18.5%)均报告为良性病变:纤维腺瘤26个,其他良性病变6个。3例患者为双侧乳腺肿物,双侧浸润性乳腺癌1例;一侧为浸润性癌、对侧为纤维腺瘤2例。与手术病理结果相对照超声引导下14G空芯针穿刺的敏感度和特异性分别为99.3%和100%,阴性预测值为96.8%,假阴性1例,假阴性率0.7%。发生穿刺部位血肿2例,穿刺区皮下瘀斑45例,无感染病例。中位随访32月未发现局部复发病例。结论超声引导下14G空芯针穿刺活检是乳腺癌有效和安全的诊断方法。

Objective To retrospectively analyze the false-negative rate of ultrasonography（US）-guided core-needle breast biopsy（CNB） in BI-RADS 4b-4c lesions through comparison with surgical excision histologic examination and assess the early and late complications.Methods One hundred and seventy patients with 173 breast lesions classified BIRADS 4b and 4c by ultrasound were performed 14-gauge core needle biopsy guided by US using local aneathsesia.All patients underwent surgical excision,including modified radical mastectomy,breast conserving surgery for invasive breast cancer or lumpectomy for benign lesions,according to the pathological results from core needle biopsy.Using the pathological results from the surgical excision samples as golden standard.The complications during preoperative period and long term complications were collected retrospectively and recorded.Results US guided 14-gauge CNB yielded 141（81.5%） malignant,and 32（18.5%） benign lesions including fibroadenoma（26 lesions） and other benign lessions（6 lesions）.In 3 patients with bilateral lesions,1 case of bilateral breast cancer and 2 cases were one side and the other side fibroadenoma.False-negative finding was encountered in 1 of 170 cases,and the false-negative rate was 0.7%（1 of 141 malignancies）.The sensitivity and specificity of the core needle biopsy histology diagnosis were 99.3% and 100% compared with the surgery pathological results.The negative predictive value（NPV） was 96.8%.The incidence of hematoma was 2 case.There were 45 cases with the local ecchymosis.There were no core needle biopsy associated infection,implantation metastasis or local recurrence during median 32 months follow-up.Conclusion Ultrasonography（US）-guided 14-gauge core-needle breast biopsy（CNB） is an effective and safe method for breast cancer diagnosis.