乳腺微创真空旋切系统(EnCor)对乳腺肿物的诊治价值及切口的选择

The Value of EnCor in the Diagnosis and Management of Breast Neoplasm and Selection of Incision

目的：探讨超声下乳腺真空旋切系统（EnCor）进行乳腺病灶切除活检的切口选择。方法采用7G旋切探针进行操作，直径5 mm。良性可能性大的病灶，应尽量考虑美容效果好的腋下皮纹线、腋中线及乳晕切口；恶性可能性大的病灶应尽可能选择病灶附近的切口。结果良性病灶均完全切除。1例选择病灶表面皮肤穿刺活检，该患者B超、钼靶、临床均高度怀疑乳腺癌，但巴德针穿刺活检阴性；1例因2处触诊不可及的可疑病灶而选择乳房表面2处切口，并且分别使用2把活检刀；3例选择乳房表面病灶附近的切口；乳晕切口32例；腋下皮纹线切口75例；其余285例均选择在腋中线切口。术后病理：乳腺纤维腺瘤299例，乳腺增生病伴纤维腺瘤样结构形成47例，乳腺导管内乳头状瘤11例，乳腺囊性增生病26例，乳腺潴留囊肿8例，重度不典型增生2例，导管内癌1例，浸润性导管癌3例。3例浸润性导管癌，其中2例肿物位于左乳肿物外上象限距离乳头1 cm，择期行乳癌根治术；1例肿物在右乳外上象限距乳头3 cm，择期行保乳术联合腋窝淋巴结清扫术。 B超术前BI-RADS分类与术后病理对比，阳性预测值75．0％（3/4），误诊率（假阳性）0．2％（1/393），漏诊率（假阴性）25．0％（1/4），准确率99．5％（395/397）。393例良性病变随访6～24个月，切口隐蔽，愈合良好，乳腺外形美观。结论拟诊为良性的病灶优先考虑美容效果选腋下皮纹线、腋中线、乳晕切口；拟诊为恶性的病灶应尽可能选择病灶附近的切口。

Objective To investigate the incision selection of EnCor for breast lesion biopsy guided by ultrasonography . Methods For benign lesions , incisions at alar skin line , axillary midline and areola of mamma were considered for good cosmetic results.For possible malignant lesions , incisions were chosen near the lesions . Results Benign lesions were completely removed . Needle biopsy on the surface of the nidus skin was chosen for 1 patient, whose B ultrasound, molybdenum, clinical diagnosis showed highly suspected breast cancer , while Bud needle puncture biopsy showed negative results ;2 incisions were cut for one case on the breast surface due to 2 unreachable palpation and suspicious lesions , and 2 biopsy knives were used respectively;the incisions near the surface of breast lesions were chosen for 3 cases;areola incisions were made for 32 cases; alar skin lines incisions were made for 75 cases;the rest 285 cases had axillary midline incisions .Postoperative pathology： there were 299 cases of breast fibroadenoma , 47 cases of mammary gland hyperplasia with fibroadenoma sample structure , 11 cases of breast intraductal papilloma , 26 cases of breast cystic hyperplasia , 8 cases of retention cyst of breast , 2 cases of severe dysplasia , 1 case of intraductal carcinoma and 3 cases of infiltrating ductal carcinoma , including 2 cases of lesions located in the left breast away from the papilla by 1 cm and treated by radical resection of breast cancer , and 1 case of the mass in the right breast away from the papilla by 3 cm, which underwent breast preserving surgery combined with axillary lymph node dissection .Compared with postoperative pathology , positive predictive value of B ultrasound was 75.0%（3/4）, misdiagnosis rate （false positive） was 0.2%（1/393）, missed diagnosis （false negative） was 25.0%（1/4） and accuracy was 99.5%（395/397）.The 393 cases of benign lesions were followed up for 6-24 months, and all of the cases recovered well with hidden incision and good cosmetic results . Conclusion The preferred procedure for patients diagnosed as benign lesions should consider incisions at alar skin lines , axillary midline and areola of mamma;for possible malignant tumor , incisions near lesions should be selected .