超声引导穿刺活检乳腺病灶的假阴性分析

False Negative of Ultrasound-guided Biopsy for Breast Lesions

目的探讨超声引导乳腺穿刺组织活检的敏感性及假阴性问题，提高超声引导穿刺活检诊断率。资料与方法回顾性分析117个超声检查诊断为BI-RADS4～5级乳腺结节的超声引导穿刺组织活检结果，比较18G内槽型切割式组织活榆针穿刺病理诊断与手术切除组织病理诊断及随访结果的一致性，并联合影像及临床评估，综合分析乳腺穿刺组织活检的准确性。结果117个结节中，术后病理诊断为恶性64个，超声引导穿刺组织活检诊断为恶性59个，其中3例导管上皮不典型增生术后病理1例诊断为导管内原位癌，2例诊断为浸润性导管癌，1例慢性炎症术后病理诊断为低分化神经内分泌癌，1例导管内乳头状瘤术后病理为导管内原位癌。超声引导穿刺组织活检对于乳腺恶性病灶的诊断敏感度为92．2％，特异度为100．0％，假阴性率为7．8％，假阳性率为0。结论使用18G内槽型切割式组织活检针行乳腺结节穿刺活检，同时联合影像及临床评估，可以提高诊断准确性。

Purpose To investigate the sensitivity and false negative problem of ultrasound-guided breast biopsy, and to improve the diagnosis rate of ultrasound-guided needle biopsy. Materials and Mothods Ultrasound-guided biopsy results of I 17 BI-RADS 4-5 stage nodules diagnosed by ultrasound were retrospectively analyzed, consistency between the 18G inner groove cutting type biopsy needle puncture biopsy diagnosis and operation pathology diagnosis and follow-up results were compared, and combined with imaging and clinical evaluation, accuracy of breast biopsy was comprehensively analyzed. Results Among the 117 nodules, 64 were diagnosed as malignant by postoperative pathology, 59 were diagnosed as malignant by Ultrasound-guided needle biopsy, of which three cases of atypical ductal hyperplasia was diagnosed as ductal carcinoma in situ in one case and invasive ducta/carcinoma in two cases by postoperative pathology, one case of chronic inflammatory was confirmed as poorly differentiated neural neuroendocrine carcinoma by postoperative pathology, and one case of intraductal papilloma was diagnosed as ductal carcinoma in situ in postoperative pathology. The sensitivity, specificity, false negative rate and false positive rate of Ultrasound-guided puncture biopsy for the diagnosis of malignant breast lesions was 92.2%, 100.0%, 7.8% and 0, respectively. Conclusion The accuracy of diagnosis can improved using 18G inner groove cutting type biopsy needle for the biopsy of breast nodules combined with imaging and clinical assessments.