钼靶联合超声引导双定位法在乳腺微钙化灶活检中的临床应用研究

Clinical application of combined localization of X-ray mammography and ultrasonography in biopsy of breast microcalcification

目的:探讨钼靶X线与超声联合定位在乳腺微钙化灶活检中的临床应用价值。方法:在钼靶下对微钙化病灶三维定位,插入双钩定位针,到达病灶后固定位置;以超声探查双钩针,找到病灶的位置后,划出皮肤标记线,再插入单钩定位针;在标记线上作3 cm切口,用特制拉钩显露并固定病灶部位的乳腺组织和单钩针,对微钙化病灶区进行旋切;切下的圆柱体标本,放在带刻度的标本台上摄片,验证钙化灶是否已被完全切除,同时确定钙化灶在标本中的三维位置供病理检查。结果:共108例乳腺微钙化病灶分类为BI-RADS 4A的患者采用以上方法。定位时病灶距双钩针距离平均为4.1 mm(小于传统方法),标本平均重量为8.5 g(小于传统方法),病灶全部被一次性精准切除。108例中阳性20例,包括不典型增生7例,导管原位癌7例,导管原位癌伴局灶浸润性癌3例,浸润性导管癌3例;阴性病例88例。微钙化灶部位及形态与乳腺癌检出无明显关系(均P>0.05)。结论:钼靶X线与超声联合定位对病灶定位准确、手术方法合理、切除标本小,并能提供病灶在标本中的精确位置进行病理检查;良性者乳房外形完全没有改变。

Objective： To assess the clinical application value of the combined localization of X-ray mammography and ultrasonography in biopsy of breast microcalcification. Methods： Under X-ray mammography, three-dimensional lesion localization was performed with the placement of a double-hook localization needle that was fixedly positioned after it reached the lesion; a skin marker line was drawn after detection of the lesion site through searching the double-hook needle with ultrasonography, and a single-hook localization needle was inserted; a 3-cm incision was made over the skin marker line, the mammary tissue bearing lesions and the single-hook needle were exposed and fixed by using special retractor, and then the lesion region was excised by using a rotary cutting tool; the cylindrical specimen was placed on a scaled specimen holder to take radiographic images for verifying the complete removal of the calcification lesions and ascertaining the three-dimensional location of the lesions in the specimen so as to facilitate the following pathological works. Results： A total of 108 patients with breast microcalcification that was classified as BI-RADS 4A underwent above procedures. The average distance of the lesion from the double hook needle was 4.1 mm （less than those by conventional methods）, the average weight of specimen was 8.5 g （lighter than those by conventional methods）, and all lesions were precisely excised by one session. Of the 108 patients, 20 cases had positive lesions that included atypical ductal hyperplasia in 7 cases, ductal carcinoma in situ of breast in 7 cases, ductal carcinoma in situ with focal invasive carcinoma in 3 cases, and invasive ductal carcinoma in 3 cases, and 88 cases had negative lesions. Both location and shape of the microcalcification lesion showed no significant relation with the detection of breast cancer （both P〉0.05）.Conclusion： Combined localization of X-ray mammography and ultrasonography has the advantages of accurate lesion localization, proper biopsy method, and small volume of specimen, as well as providing precise position of lesions in the specimen for pathological examination. Further, it does not exert any influence on the breast appearance in patients with benign lesions.