乳腺X线三维立体定位真空辅助活检技术要点探析

Analysis on the technical points of vacuum-assisted breast biopsy under X-ray stereotactic guidance

目的:探讨乳腺X线三维立体定位真空辅助活检系统对乳腺内可疑恶性成簇钙化病变穿刺活检的技术要点。方法:回顾并分析天津医科大学肿瘤医院2017年11月—2018年10月49例乳腺内有成簇钙化病变的患者行X线三维立体定位真空辅助活检的临床资料。结果:49例患者中2例因乳房压迫厚度较薄无法实施旋切、1例因乳房压迫后病变距离乳头位置较近而放弃手术,最终完成手术46例。39例应用针槽20 mm旋切探针,7例应用针槽12 mm旋切探针;1次压迫乳房检出钙化灶26例,经改变体位压迫乳房检出钙化灶5例,未改变体位但重复压迫乳房检出钙化灶15例;进针后定位准确43例,定位不准确3例;旋切后标本组织X线摄影后均显示钙化。除术中出血外未出现严重并发症以及术后感染。结论:乳腺X线三维立体定位真空辅助活检操作中乳腺的摆位、定位点的选择、曝光条件、曝光次数的选择、旋切探针型号的选择、旋切中方向的侧重及并发症的处理是技术关键,对病变的准确切除、患者接受X线剂量的多少、术中及术后并发症的发生起决定性作用。

Objective:To explore the key points of the technique of breast X-ray stereotactic guidance positioning vacuumassisted biopsy system for needle biopsy of suspected malignant cluster calcification lesions in breast.Methods:Retrospective analysis was performed on the clinical data of 49 patients with clustered calcification in the breast who underwent X-ray stereotactic guidance vacuum-assisted biopsy from Nov.2017 to Oct.2018 in Tianjin Medical University Cancer Institute and Hospital.Results:Among the 49 patients,2 were unable to undergo rotation due to the thin thickness of the breast compression,and 1 was unable to complete the surgery due to the close proximity of the lesion to the nipple.The needle groove 20 mm rotary probe was applied in 39 cases,and the needle groove 12 mm rotary probe was applied in 7 cases.Calcification foci were detected in 26 cases of breast compression at one time,calcification was detected in 5 cases by the change of body position and 15 cases of calcification foci were detected by repeatedly pressing breast without changing body position.There were 43 cases with accurate positioning and 3 cases with inaccurate positioning.Calcification was shown on X-ray of the tissue after rotation.There were no serious complications and postoperative infection except intraoperative hemorrhage.Conclusion:Breast X-ray stereotactic guidance of lesions in the vacuum assisted biopsy operation,the placement of breast,the choice of anchor point,exposure conditions and reduce exposure frequency,whirling probe type selection,the direction of the rotary cutting and complications of the treatment is the key technology with it.This determines the complete removal of the lesion,the dose of X-ray the patient receives,and the incidence of intraoperative and postoperative complications.