【摘要】 目的 探讨X线引导下乳腺立体定位活检的临床应用及适应证。方法 回顾分析173例临床不可触摸的乳腺病变(non-palpable breast lesion,NPBL)的临床及影像资料。23例行核芯针穿刺活检(stereotactic core needle biopsy,SCNB),其中16例活栓后行外科手术,7例随访;150例(156个病灶)行X线立体定位导丝切检(stereotactic needle localized biopsy,SNLB)1次定位成功并完整切除。根据美国放射学会乳腺影像报告与数据系统(BI-RADS)对全组病例进行分类;对经手术病理确诊的166例172个病灶BI-RADS类别与病理良恶性进行统计学分析。结果 本组病例均为BI-RADS 3～5类,术后病理乳腺癌49个,非典型增生8个,良性病变115个,BI-RADS 3、4、5类恶性率依次为:1.3%(1/73)、42%(37/88)、100%(11/11);3、4、5类病灶恶性率间存在差异(P<0.05),4B与4C类恶性率无统计学差异(P>0.05),但均显著高于4A类(P<0.05)。结论 对BI-RADS 4类以上病变进行定位活检,对部分BL-RADS 3类及4A类病变拟采用SCNB活检,对于BL-RADS 4B、4C类及5类拟行SNBL活检。更多还原

【Abstract】 Objective To explore the clinical application and indications of stereotactic biopsy under X-ray guidance for non-palpable breast lesions(NPBL).Methods Clinical and imaging data of 173 patients with NPBL were retrospectively analyzed.In 173 cases,23 patients underwent stereotactic core needle biopsy(SCNB),after that,16 patients received surgical resection and 7 patients were followed clinically.In addition,150 patients underwent X-ray guided stereotactic needle localized biopsy(SNLB).A total number of 156 breast lesions in 150 patients were completely resected.172 lesions resected in 166 patients were evaluated according to the breast imaging reporting and data system(BI-RADS) of American College of Radiology.Imaging diagnosis and pathological results were compared,and the statistical correlation between the BI-RADS category and pathological results was analysed.Results 49lesions were breast cancer,8 lesions were atypical hyperplasia and 115 lesions were benign lesions.The malignant rates of BI-RADS category 5 was higher(100%,11/11),followed by BI-RADS 4(42%,37/88) and 3(1.3%,1/73),respectively.Moreover,the malignant rate of patients defined as BI-RADS 4B and 4C was of no statistically significant difference(P>0.05),but both of the above-mentioned were higher than that in BIRADS 4A(P<0.05).Conclusion X-ray-guided breast biopsy is an important and crucial approach for patients with NPBL categorized above BI-RADS 4.SNLB should be performed in patients with breast lesions defined as BI-RADS 4B,4C and 5.In case of BI-RADS 3 and 4A,SCNB may be considered as a right choice.更多还原