乳腺三维立体定位引导下的钼靶可疑病灶活检的临床应用价值研究

Clinical Value of Mammography Biopsy Guided by Three-dimensional Localization of Mammary Gland

目的:探讨三维立体定位引导下钩针定位开放活检和三维立体定位引导下真空辅助乳腺微创旋切活检(stereotactic vacuum assisted breast biopsy,SVABB)用于乳腺钼靶可疑病灶的临床诊断价值。方法:选取本院于2016年1月-2017年8月收治的X线钼靶发现的100例患者(136个乳腺病灶)为研究对象。其中50例(75个病灶)采取钼靶三维立体引导钩针定位开放活检(开放活检组),50例(61个病灶)行SVABB(SVABB组)。以术后病理学诊断为金标准,比较两种活检方式成功率、手术指标和并发症发生情况,以及对乳腺癌诊断的敏感度、特异度、漏诊率、病理组织学低估率。结果:开放活检组医疗费用低于SVABB组,差异有统计学意义(P<0.05);SVABB组瘢痕大小、住院时间均明显低于开放活检组,差异均有统计学意义(P<0.05);而两组术中出血量及手术时间比较,差异均无统计学意义(P>0.05)。SVABB组活检成功率100%,显著高于开放活检组的85.3%,差异有统计学意义(P<0.05)。以术后病理学检查结果判断为金标准,开放性活检诊断乳腺病灶良恶性的敏感度83.0%,特异度90.9%,漏诊率17.0%,误诊率9.1%。SVABB诊断乳腺病灶良恶性的敏感度97.7%,特异度93.8%,漏诊率2.3%,误诊率6.2%。两组活检均未出现组织学低估。SVABB组并发症发生率为10.0%(5/50),明显低于开放活检组的30.0%(15/50),差异有统计学意义(P<0.05)。结论:三维立体定位引导下真空辅助乳腺微创旋切活检操作便捷,较钼靶可疑病灶钩针定位开放活检病理诊断结果准确可靠,病理取材更容易,瘢痕小,微创美观,对于乳腺病灶的早期筛查诊断具有重要价值。

Objective:To explore the value of the stereotactic core needle open biopsy and stereotactic vacuum assisted breast biopsy(SVABB)in the diagnosis of breast lesions.Method:100 patients(136 breast lesions)found in the X-ray molybdenum target in our hospital from January 2016 to August 2017 were selected as the subjects.50 cases(75 lesions)underwent the stereotactic core needle open biopsy(open biopsy group),50 cases(61 lesions)received SVABB(SVABB group).The success rate of two biopsy methods,operative index and complication,as well as the diagnosis sensitivity,specificity,missed diagnosis rate and pathological histology underestimation rate of breast cancer of the two biopsy methods were compared with the diagnosis of postoperative pathology was the gold standard.Result:The medical expenses of open biopsy group was lower than that in SVABB group,the difference was statistically significant(P<0.05);the size of scar and the length of hospitalization in SVABB group were significantly lower than those of open biopsy group,the differences were statistically significant(P<0.05);and there were no statistically significant differences in intraoperative bleeding and operation time between the two groups(P>0.05).The success rate of biopsy in SVABB group was 100%,significantly higher than 85.3% of open biopsy group,the difference was statistically significant(P<0.05).The pathological examination results were judged as gold standard,the sensitivity of open biopsy to the diagnosis of benign and malignant mammary lesions was 83.0%,the specificity was 90.9%,the missed diagnosis rate was 17.0%,the misdiagnosis rate was 9.1%.Sensitivity of SVABB in diagnosis of benign and malignant breast lesions was 97.7%,specificity 93.8%,missed diagnosis rate 2.3%,misdiagnosis rate 6.2%.The complication rate of the SVABB group was 10.0%(5/50),significantly lower than 30.0%(15/50)in the open biopsy group,the difference was statistically significant(P<0.05).Conclusion:Compared with the molybdenum target suspicious focus of the needle crochet open biopsy,the stereotactic vacuum assisted breast biopsy is convenient and easier for pathologic sampling,with accurate and reliable pathological diagnosis results,and the minimally invasive technique has a low complication rate with excellent results,which has important value for early diagnosis of breast cancer.