乳腺导管原位癌超声引导空心针穿刺活检与麦默通活检对比研究

Comparative study of ultrasound-guided core needle biopsy and Mammotome biopsy in breast ductal carcinoma in situ

目的乳腺导管原位癌(ductal carcinoma in situ,DCIS)是指乳腺导管内上皮细胞恶性增殖,但未超出周围基底膜的恶性病变,有进一步发展为浸润性导管癌(invasive ductal carcinoma,IDC)的风险。本研究通过对比研究超声引导空心针穿刺活检(core needle biopsy,CNB)和麦默通(Mammotome,MMT)活检,探讨两种活检方法在DCIS诊断中的应用价值。方法回顾性分析2014-08-01-2017-12-31广西医科大学附属肿瘤医院确诊的91例DCIS女患者临床资料(96个乳腺病灶)。根据超声活检方法不同分为CNB组和MMT组。以手术后病理诊断为金标准,比较CNB和MMT两种方法对DCIS术前诊断的准确率。结果 96个乳腺病灶的超声BI-RADS 4类占96.88%(93/96),3类占3.12%(3/96)。超声引导活检病灶CNB组52个,MMT组44个,与术后病理比较,96个病灶活检病理阳性率为92.71%(89/96),假阴性率7.29%(7/96)。CNB组活检病理结果为DCIS 34个,导管原位癌伴微浸润(ductal carcinoma in situ with microinvasion,DCIS-MI)12个,导管内乳头状瘤伴不典型增生1个,乳腺增生3个,乳腺导管重度不典型增生2个;CNB组活检阳性率88.46%(46/52),假阴性率11.54%(6/52)。MMT组活检病灶的病理结果为DCIS 37个,DCIS-MI5个,小叶原位癌1个,导管内乳头状瘤伴不典型增生1个;MMT组活检阳性率97.72%(43/44),假阴性率2.27%(1/44)。CNB组和MMT组活检检出率比较差异无统计学意义,P=0.178。结论超声引导CNB和MMT活检在DCIS中的诊断准确率高,对DCIS早期诊断具有关键的辅助作用。对于高度可疑DCIS的病灶超声引导活检建议采用CNB,更有利于活检诊断DCIS后外科制定完整切除病灶的诊断、治疗方案。

OBJECTIVE The purpose of this study was to compare ultrasound-guided core needle biopsy(CNB)and Mammotome(MMT)biopsy to explore the value of these two biopsy methods in the diagnosis of breast ductal carcinoma in situ(DCIS).METHODS Retrospective analysis was performed on 96 breast lesions in 91 female patients diagnosed with DCIS in our hospital from August 1,2014 to December 31,2017.According to different biopsy methods,the patients were divided into CNB group and MMT group.With surgery histopathological diagnosis as the gold standard,the accuracy of CNB and MMT in preoperative diagnosis of DCIS was compared.RESUITS There were 96.88%(93/96)BI-RADS category 4 and 3.12%(3/96)BI-RADS category 3 in 96 breast lesions.Ultrasound-guided biopsy was performed on 52 lesions in CNB group and 44 lesions in MMT group.Compared with surgery pathology,the positive rate of biopsy on 96 lesions was 92.71%(89/96)and the false negative rate was 7.29%(7/96).The pathological results of biopsy in CNB group were 34 DCISs,12 ductal carcinoma in situ with microinvasion(DCIS-MI)1 intraductal papilloma with atypical hyperplasia,3 breast hyperplasia,and 2 breast ducts with severe atypical hyperplasia.The positive rate of biopsy in CNB group was88.46%(46/52),and the false negative rate was 11.54%(6/52).The pathological results of biopsy in MMT group were37 DCISs,5 DCIS-MIs,1 lobular carcinoma in situ,and 1 intraductal papilloma with atypical hyperplasia.The positive rate of biopsy in MMT group was 97.73%(43/44),and the false negative rate was 2.27%(1/44).There was no significant difference in the detection rate of biopsy between CNB group and MMT group(P=0.178).CONCLUSIONS Ultrasoundguided CNB and MMT biopsy has a high diagnostic accuracy in DCIS and plays a key auxiliary role in the early diagnosis of DCIS.For ultrasound-guided biopsy of lesions with highly suspicious DCIS,CNB is recommended,which is more conducive to the diagnosis of DCIS by biopsy and the formulation of surgery and treatment plan for complete resection of lesions.