立体定位引导真空辅助空心针乳腺穿刺活检在诊断乳腺微钙化中的应用价值

Clinical application value of stereotactic vacuum-assisted breast biopsy in breast microcalcification

目的:探讨立体定位引导真空辅助空心针乳腺穿刺活检(SVAB)在诊断乳腺微钙化中的应用价值。方法:2015年1月至2017年1月,对解放军474医院乳腺外科门诊治疗的75例钼靶诊断乳腺微钙化患者分别行SVAB(n=42)和超声引导真空辅助空心针乳腺穿刺活检(USVAB)(n=33),活检被诊断为乳腺癌或导管原位癌患者,手术切除病灶。分析标本的病理组织学和影像学特征,比较两种活检方式的诊断价值,并统计患者出现的不良反应和预后情况。结果:75例钼靶诊断乳腺微钙化患者病理诊断为导管原位癌32例,浸润性导管癌3例,浸润性小叶癌11例,均行手术治疗,其余29例病理为良性。以病理结果为金标准,SVAB检测的灵敏度、特异度、阳性预测值和诊断准确度均高于USVAB(均P<0.05),且SVAB的误诊率和漏诊率均低于USVAB(均P<0.05),但两种方法检测的阴性预测值比较,差异无统计学意义(P>0.05)。3例患者出现术中出血,2例术后出现血肿、瘀斑,3个月内自然吸收,无穿刺部位感染病例;随访期间,所有良性患者伤口愈合良好,乳房外观满意,未发现恶性肿瘤,诊断为乳腺癌的病例均无复发。结论:SVAB是一种有效的、可靠的乳腺微钙化的诊断方法,具有准确、微创,术后并发症少的优点。

Objective:To compare the clinical application value of stereotactic vacuum-assisted breast biopsy(SVAB)and ultrasound-guided vacuum-assisted breast biopsy(USVAB)in the diagnosis of breast microcalcification.Methods:75 patients with breast microcalcification diagnosed by molybdenum target from January 2015 to January 2017 were respectively treated with SVAB(n=42)and USVAB(n=33),and the lesions were removed surgically in patients with breast cancer or ductal carcinoma in situ diagnosed by biopsy.The histopathological and imaging characteristics of the specimens were analyzed,and the diagnostic value of the two biopsy methods was compared.The adverse reactions and prognosis of the patients were counted.Results:75 patients with mammographic microcalcification were diagnosed as ductal carcinoma in situ(32 cases),invasive ductal carcinoma(3 cases),and invasive lobular carcinoma(11 cases)by pathology.All patients underwent surgical treatment,and the remaining 29 cases were benign.To pathology results for the gold standard,the sensitivity,specificity,positive predictive value and diagnostic accuracy of SVAB were higher than those of USVAB(P<0.05),and the misdiagnosis rate and missed diagnosis rate of SVAB were lower than those of USVAB(P<0.05).However,there was no significant difference in the negative predictive value between the two methods(P>0.05).3 cases had intraoperative hemorrhage,2 patients hematoma and ecchymosis after operation,which were absorbed naturally within 3 months without puncture site infection.During the follow-up period,all benign patients had good wound healing,satisfactory breast appearance,no malignant tumors,and no cases diagnosed as breast cancer.Conclusion:SVAB is an effective and reliable method for the diagnosis of breast microcalcification.It has the advantages of high accuracy,minimally invasive and few complications after operation.