穿刺针直径及声像学特征对超声引导乳腺穿刺活检准确性的影响

Impact of needle size and sonographic feature on accuracy of ultrasound-guided breast biopsy

目的比较16G及18G空芯针对不同声像学特征的乳腺病灶行超声引导穿刺活检的准确性。方法行超声引导16G及18G空芯针乳腺穿刺活检后外科手术切除的病例955例。超声引导穿刺活检病理结果与手术切除病理结果对比,根据超声声像学特征分组分析穿刺活检的符合率、敏感性、假阴性率、低估率。结果穿刺活检病理结果中,恶性占84.1%,高危占8.4%,良性占7.5%。16G及18G穿刺活检与术后病理的总符合率分别为92.4%及92.8%;完全敏感性及假阴性率均分别为98.6%及1.4%;高危低估率及导管内癌低估率分别为16G:48.0%及46.2%;18G:53.3%及41.2%。两种方法间无统计学差异(P>0.01)。同时,对于两种方法,肿块型病灶的穿刺符合率均明显高于非肿块型病灶(P<0.01)。对于直径小于等于10 mm的肿块型病灶,穿刺符合率明显降低(P<0.01)。含钙化病灶与不含钙化病灶间的穿刺符合率无统计学差异(P>0.01)。结论超声引导16G及18G空芯针穿刺活检对于诊断直径大于10 mm的肿块型乳腺病灶均是准确的方法。

Objective To assess the accuracy of ultrasound-guided 16G and 18G core needle biopsy for detecting ultrasound visible breast lesions with different sonographic features. Methods A total of 955 sonographically detected breast lesions examined with ultrasound-guided core needle biopsy （US-CNB） and subsequently surgically excised from July 2005 to July 2012 were retrospectively reviewed. Histological findings of US-CNB and the surgical specimens were analyzed for agreements, sensitivities, false negative rates, and underestimate rates according to different sonographic features. Results The pathological results of the US-CNB showed malignant lesions in 84.1%, high-risk lesions m 8.4%, and benign lesions in 7.5% of the samples. The overall agreement rates were 92.4% for 16G CNB and 92.8% for 18G CNB; their complete sensitivities and false negative rates were both 98.6% and 1.4%, respectively; the high-risk underestimate rates and DCIS underestimate rates were 48.0% and 46.2% for 16G CNB vs 53.3% and 41.2% for 18G CNB, showing no significant difference between the two groups （P〉0.01）. For both 16G and 18G CNB, the agreements were better for mass lesions than for non-mass lesions （P〈0.01）. For the mass lesions with a diameter no greater than 10 nun, the agreement rates were lower than the overall data （P〈0.01）. Calcification in the lesions did not affect the agreement rates （P〉0.01）. Conclusion Ultrasound-guided 16G and 18G CNB are both accurate methods for evaluating ultrasound visible breast mass lesions with a diameter larger than 10 mm.