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目的对目前乳腺 X 线立体定位下常用的3种活检方法进行评价。方法自2000年1月起,对361例乳腺病灶进行乳腺 X 线立体定位活检,其中弹射式空芯针活检(ST-CNB)73例、真空辅助旋切活检(ST-VAB)74例以及手术活检214例。在中位随访时间为18个月(6～66个月)时,比较3种 X 线立体定位活检方法的准确性以及临床应用特点。结果乳腺 X 线立体定位手术活检、ST-CNB 和 ST-VAB 诊断乳腺癌的漏诊率分别为0、2.7%和0。微创活检诊断乳腺导管上皮不典型增生的低估率为33%,诊断乳腺导管内癌的低估率为53%。微创活检在操作时间、对乳房外形的影响及并发症等方面明显优于手术活检。微创活检使69%的可疑病灶避免了手术。结论乳腺 X 线立体定位微创活检,尤其是真空辅助旋切活检是一种准确、安全、简便的诊断方法,因此可作为乳腺 X线中度可疑(BIRADS-4)病灶的首选诊断方法,但如果活检结果为不典型增生应进一步行 X 线立体定位手术活检;而对于高度可疑(BIRADS-5)病灶,宜直接选择手术活检诊断。
Objective To evaluate the commonly used three biopsy methods under mammography. Methods From January 2000, 361 cases of breast lesions underwent mammography biopsy. Among them, 73 cases of ST-CNB and 74 cases of ST-VAB underwent ST-VAB Biopsy of 214 cases. At a median follow-up of 18 months (range 6 to 66 months), the accuracy and clinical features of the three X-ray stereotactic biopsies were compared. Results Breast X-ray stereotactic biopsy, ST-CNB and ST-VAB diagnosis of breast cancer, the rate of missed diagnosis was 0,2.7% and 0. The underestimation rate of minimally invasive biopsy in the diagnosis of atypical hyperplasia of breast ductal epithelium was 33%, and the underestimation rate of ductal carcinoma in ductal carcinoma was 53%. Minimally invasive biopsy in operation time, the impact on breast shape and complications were significantly better than biopsy. Minimally invasive biopsy avoided 69% of the suspicious lesions. Conclusion The minimally invasive biopsy, especially vacuum assisted biopsy, is an accurate, safe and simple diagnostic method for mammography. Therefore, it can be used as the first choice for the diagnosis of BIRADS-4 in mammography. If the biopsy results in atypical hyperplasia, further X-ray stereotactic biopsy should be performed; and for highly suspected (BIRADS-5) lesions, surgical biopsy should be selected for direct diagnosis.