乳腺X线三维立体定位真空辅助乳腺活检在乳腺X线可疑钙化诊断中的价值

Application of Breast X-ray Three-dimensional Stereotactic Vacuum-assisted Breast Biopsy in the Diagnosis and Treatment of Suspicious Calcifications

目的探讨乳腺X线三维立体定位真空辅助乳腺活检在可疑钙化中的应用价值。方法2016年1月~2018年12月对242例临床不可触及且超声检查阴性,乳腺X线可疑钙化,在乳腺X线三维立体定位下采用EnCor真空辅助乳腺活检系统旋切取活检,利用乳腺X线0°导航位和±15°立体定向确定病灶位置后,从该位置插入旋切刀进行微创旋切取活检。结果242例顺利完成活检,活检病理诊断良性病变205例(非典型病变16例),恶性病变37例(导管原位癌30例,浸润性导管癌7例)。37例恶性病变手术治疗,7例为浸润性导管癌,其中5例钙化完全切除,手术时无肿瘤残留,2例有残余微钙化和残余肿瘤;30例为导管原位癌(ductal carcinoma in situ,DCIS),其中28例钙化病灶完全切除,2例活检术中有肿瘤残留[手术切除标本示导管内癌伴早期浸润,DCIS升级率为6.7%(2/30)]。11例非典型性病变手术治疗,10例术后病理诊断为腺病,1例升级为DCIS,非典型增生升级率9.0%(1/11);5例非典型病变在3年的随访中无可疑发现。结论乳腺X线立体定位下真空辅助乳腺活检可以较好地应用于可疑钙化的微创活检,值得推广。

Objective To explore the value of breast X-ray three-dimensional stereotactic vacuum-assisted breast biopsy for suspicious calcified lesions.Methods From January 2016 to December 2018,the EnCor vacuum assisted breast biopsy system was used to perform three-dimensional stereotactic mammography in 242 cases of suspicious calcification under breast X-ray with clinically inaccessible palpation and negative ultrasound examination.A rotary scalpel was introduced for minimally invasive rotational biopsy after the site of the lesion was identified by 0°navigation position and±15°stereotactic mammography.Results The biopsy was completed successfully in all the 242 cases.Biopsy pathology diagnosed 205 cases of benign lesions(including 16 cases of atypical lesions)and 37 cases of malignant lesions(30 cases of ductal carcinoma in situ and 7 cases of invasive ductal carcinoma).The 37 cases of malignant lesions were treated surgically.Of the 7 cases of invasive ductal carcinoma,the calcification was completely removed in 5 cases without residual tumor during operation,and residual microcalcification and residual tumor were found in 2 cases.Of the 30 cases of ductal carcinoma in situ(DCIS),calcified lesions were completely removed in 28 cases,and residual tumor was found in 2 cases during biopsy[surgical resection specimens showed ductal carcinoma with early invasion,and the DCIS upgrade rate was 6.7%(2/30)].Surgery was used to treat 11 cases of atypical lesions,10 of which were pathologically shown to be adenosis,and 1 was upgraded to DCIS.The atypical hyperplasia escalation rate was 9.0%(1/11).No questionable findings was observed in 5 cases of atypical lesions during 3-year follow-ups.Conclusion Vacuum-assisted breast biopsy under breast X-ray three-dimensional stereotactic positioning can be applied to minimally invasive biopsy of suspected calcified lesions,which is worthy of promotion.