麦默通在乳腺囊肿切除及活检中的价值初探

Value of Mammotome for Excision and Biopsy in Breast Cysts

目的探讨麦默通(MMT)进行乳腺囊肿切除活检的手术指征及MMT对乳腺囊肿的辅助诊断价值。方法 2010年5月至2011年11月期间,根据笔者所在科室拟出的乳腺囊肿MMT手术指征(单发囊肿、内部回声不均且直径大于1cm者;多发囊肿伴有严重无规律疼痛或触诊局部腺体增厚并经3个月药物治疗无效者;有乳腺癌发生高风险者;囊肿与低回声结节、乳管扩张等病灶并存者;病变周围腺体组织彩超下回声杂乱或血供丰富者),选择了78例患者进行MMT切除活检,将术后病理结果与术前彩超检查结果进行对照。结果 78例患者术前彩超检查发现双乳多发囊肿40例,多发囊肿+触诊不可扪及的低回声结节38例。术中彩超示高风险病变42例,低风险病变36例。术后病理检查结果提示彩超高风险组病理诊断囊性增生症27例,非典型增生2例,乳腺癌1例;彩超低风险组诊断囊性增生症19例。术前彩超检查对乳腺囊肿诊断的敏感度为61.22%(30/49),特异度为58.62%(17/29),准确度为60.26%(47/78)。本组切除病灶(13.00±8.16)个,手术时间(74.25±22.68)min。术后平均住院1 d出院,出现局部血肿2例,无其他并发症发生。结论笔者所在科室根据乳腺囊肿患者的临床表现以及术前彩超的影像学改变所拟定的MMT手术指征简单实用。MMT多点切除手术美观、安全,MMT切除活检有助于医生了解高危囊肿患者的病理类型,发现癌前病变或早期癌,但仍需严格规范乳腺囊肿的MMT手术活检指征。

Objective To discuss the surgical indication of mammotome（MMT） operation and its auxiliary diagnosis value on breast cysts.Methods Seventy-eight patients with breast cysts from May 2010 to November 2011 in this hospital were enrolled.Excision and biopsy were performed according to the following guidelines：Single cyst with inhomogeneous interna echoes and diameter at least 1 cm;Multiple cysts associated with irregular？megalgia,localized thickening？of breast or？ineffective drug treatment after three months;High risk of breast cancer;Hypoechoic nodules and laticifers exaggerated cysts;Ultrasonography showed disorderly echo and abundant blood supply in glandular tissues around the lesions.The result of preoperative ultrasound was compared with that of postoperative pathology diagnosis.Results In these 78 breast cysts patients with preoperative ultrasound diagnosis,40 cases were breast multiple cysts,38 cases were multiple cysts plus untouchable hypoecho nodules;42 cases were high risk lesions,and the other 36 cases were low risk lesions.Postoperative pathology diagnosis revealed 27 cases of cystic hyperplasia,2 cases of atypical hyperplasia,and 1 case of breast cancer in the ultrasonic high risk lesions,and 19 cases of cystic hyperplasia in the ultrasonic low risk lesions.Ultrasound diagnostic accuracy rate was 60.26%？（47/78）,sensitivity was 61.22%？（30/49）,and specificity was 58.62%？（17/29）.The number of resection lesions was 13.00±8.16,the time of operation was（74.25±22.68） min.The average hospital stay was 1 d after surgery.The local hematoma occurred in 2 cases and no other complications occurred during one month of follow-up.Conclusions The guidelines of MMT protocoled according to clinical manifestation of breast cyst patients and imaging of high-frequency ultrasound in author＇s department are simple and utility.Minimal excision and biopsy via MMT can confirm the histological type and help for early diagnosis of breast cancer and precancerous lesion.It is important and necessary to standardize the surgical indications of MMT in the clinical work.