超声引导活检乳腺结节病灶所致病理组织学低估的分析

Analysis of Ultrasound-guided Biopsy of Breast Nodules Caused by Histopathology Underestimated

目的观察并探讨超声引导活检乳腺结节病灶所致病理组织学低估的相关因素。方法取我院2012年2月至2014年3月期间收治的乳腺肿瘤患者240例,术前均接受超声引导乳腺结节穿刺活检,详细记录穿刺病理活检结果,并取手术切除标本的临床病理诊断结果为对照,对比病理穿刺活检造成的误诊以及病理组织学低估相关影响因素。结果术前240例患者共接受病理穿刺活检262次,穿刺活检诊断结果符合临床病理诊断结果共计194次,占80.8%;误诊9次,占3.8%,病理组织学低估共计37次,占15.4%。且16 g针穿刺活检造成病理组织学低估的发生率明显低于18G穿刺针活检结果(P<0.05);穿刺取样局限、乳腺肿瘤多样性组织成分以及未精准定位病灶是导致超声引导活检乳腺结节病灶病理组织学低估的主要影响因素。结论术前超声引导穿刺活检乳腺结节病灶通常会受到穿刺取样偏倚、肿瘤组织内部多样化成分、穿刺活检样本组织量获取过少的影响而出现病理组织学低估现象,在临床检验过程中应注意对此进行纠正,例如采用管径更大的穿刺活检针管、提高穿刺次数等方法确保所取组织样本量满足病理诊断需求,减少超声引导活检乳腺结节病灶过程中组织学诊断低估现象的发生率。

Objective To observe and explore ultrasound - guided biopsy of breast nodules caused by factors histopathological underestimated. Methods Selected 240 cases of breast cancer patients during February 2012 - March 2014 in this hospital for the study,patients underwent ultrasound - guided biopsy of breast nodules,a detailed record needle biopsy results,and took the results of surgical resection of clinical pathology specimens as control Misdiagnosis and comparative pathology biopsy pathology caused underesti- mation school related factors. Results Preoperative patient received a total of 240 cases of 262 biopsy pathology, diagnostic biopsy re- sults consistent with the clinical and pathological diagnosis totaled 194,accounting for 80.8% ;misdiagnosed 9 times, accounting for 3. 8% histopathological underestimate total 37 ,accounting for 15.4 %. 16 g needle biopsy and histopathology caused underestimate the incidence was lower than the 18G needle biopsy results,there was statistical significance（P 〈 0.05 ） ;puncture sampling limitations, the diversity of breast tumor tissue eomposition and no precise positioning lesions were the main factors leading to breast nodules ultra- sound - guided biopsy histopathoiogy underestimated. Conclusion Preoperative ultrasound - guided biopsy of breast nodules are usual- ly subject to puncture sampling bias, diverse components inside the tumor tissue, tissue biopsy sample volume to obtain too little impact on the emergence of histological underestimated phenomenon in clinical testing process should Note that this be corrected, such as u- sing a larger diameter needle biopsy, and other methods to ensure improved puncture times the amount of tissue samples taken to meet the needs of the pathological diagnosis ,ultrasound - guided biopsy of the breast to reduce the nodules during the histological diagnosis underestimated phenomenon rate.