空芯针穿刺活检术与微创旋切活检术在乳腺疾病诊断中的应用比较

Comparison of clinical application of core needle biopsy and vacuum-assisted biopsy in breast disease diagnosis

目的探讨空芯针穿刺活检术(core needle biopsy, CNB)与微创旋切活检术(vacuum-assisted biopsy, VAB)对有活检指征患者的临床诊断价值,比较两种方法在乳腺疾病诊断、免疫组织化学判断及荧光原位杂交(fluorescence in situ hybridization, FISH)检验等方面的差异。方法选取150例行CNB的患者,同时选择150例年龄、肿块大小和乳腺影像报告和数据系统(breast imaging reporting and data system, BI-RADS)分类情况相似的行VAB的病例进行配对分析,统计两种活检方式诊断的准确率及术前和术后免疫组织化学、FISH检验的符合率,同时比较两种活检方式术中和术后并发症情况。结果 VAB组与CNB组术前、术后病理诊断一致率分别为98.0%和96.7%(P=0.395)。VAB组65例导管内原位癌(ductal carcinoma in situ, DCIS)中5例为浸润性导管癌(invasive ductal carcinoma, IDC),CNB组64例DCIS中22例为IDC(P=0.034)。VAB组未发现非典型性导管增生(atypical ductal hyperplasia, ADH)病例的鉴定误差,CNB组2例ADH中1例为IDC(P=0.021)。VAB比CNB需要更长的操作时间(P<0.01),疼痛评分报告VAB的疼痛程度与CNB相似(P=0.962)。结论空芯针穿刺活检术是一种简便易行、安全且并发症少的可靠诊断技术,值得临床推广应用。而微创旋切活检术针体更粗、取材更充分,可能在免疫组织化学的判断上更具优势,病理符合率也更加明显,特别是对于IDC低估率明显降低。

Objective To investigate the clinical diagnostic value of core needle biopsy(CNB) and vacuum-assisted biopsy(VAB) in patients with biopsy indications, and to compare the differences of the two methods in breast disease diagnosis, immunohistochemical judgment and fluorescence in situ hybridization(FISH) test. Methods A total of 150 patients undergoing CNB were enrolled. And 150 patients undergoing VAB with similar age, mass size, and breast imaging reporting and data system(BI-RADS) classification were selected for paired analysis. The diagnostic accuracy and the coincidence rate of immunohistochemistry and FISH test before and after operation were statistically analyzed. The intraoperative and postoperative complications of the two biopsy methods were also analyzed. Results The coincidence rates of pathological diagnosis between the VAB group and the CNB group were 98.0% and 96.7%(P=0.395). In the VAB group, 5 cases among 65 cases of ductal carcinoma in situ(DCIS) were invasive ductal carcinoma(IDC), and in the CNB group, 22 cases among 64 cases of DCIS were IDC(P=0.034). The identification error of atypical ductal hyperplasia(ADH) cases was not found in the VAB group, and 1 of 2 cases of ADH in the CNB group was IDC(P=0.021). VAB required significantly longer time than CNB(P<0.01), whereas the degree of pain was similar(P=0.962). Conclusion Core needle biopsy is a reliable diagnostic technique that is simple, safe and has fewer complications. It is worthy of clinical application. The vacuum-assisted biopsy has a thicker needle and more adequate material, which may have more advantages in the judgment of immunohistochemistry, and the pathological coincidence rate is more obvious. It can significantly reduce the underestimate rate of IDC.