【摘要】 目的探讨超声下乳腺真空旋切系统(EnCor)进行乳腺病灶切除活检的切口选择。方法采用7G旋切探针进行操作,直径5 mm。良性可能性大的病灶,应尽量考虑美容效果好的腋下皮纹线、腋中线及乳晕切口;恶性可能性大的病灶应尽可能选择病灶附近的切口。结果良性病灶均完全切除。1例选择病灶表面皮肤穿刺活检,该患者B超、钼靶、临床均高度怀疑乳腺癌,但巴德针穿刺活检阴性;1例因2处触诊不可及的可疑病灶而选择乳房表面2处切口,并且分别使用2把活检刀;3例选择乳房表面病灶附近的切口;乳晕切口32例;腋下皮纹线切口75例;其余285例均选择在腋中线切口。术后病理:乳腺纤维腺瘤299例,乳腺增生病伴纤维腺瘤样结构形成47例,乳腺导管内乳头状瘤11例,乳腺囊性增生病26例,乳腺潴留囊肿8例,重度不典型增生2例,导管内癌1例,浸润性导管癌3例。3例浸润性导管癌,其中2例肿物位于左乳肿物外上象限距离乳头1 cm,择期行乳癌根治术;1例肿物在右乳外上象限距乳头3 cm,择期行保乳术联合腋窝淋巴结清扫术。B超术前BI-RADS分类与术后病理对比,阳性预测值75.0%(3/4),误诊率(假阳性)0.2%(1/393),漏诊率(假阴性)25.0%(1/4),准确率99.5%(395/397)。393例良性病变随访6~24个月,切口隐蔽,愈合良好,乳腺外形美观。结论拟诊为良性的病灶优先考虑美容效果选腋下皮纹线、腋中线、乳晕切口;拟诊为恶性的病灶应尽可能选择病灶附近的切口。更多还原

【Abstract】 Objective To investigate the incision selection of EnCor for breast lesion biopsy guided by ultrasonography.Methods For benign lesions,incisions at alar skin line,axillary midline and areola of mamma were considered for good cosmetic results.For possible malignant lesions,incisions were chosen near the lesions.Results Benign lesions were completely removed.Needle biopsy on the surface of the nidus skin was chosen for 1 patient,whose B ultrasound,molybdenum,clinical diagnosis showed highly suspected breast cancer,while Bud needle puncture biopsy showed negative results;2 incisions were cut for one case on the breast surface due to 2 unreachable palpation and suspicious lesions,and 2 biopsy knives were used respectively;the incisions near the surface of breast lesions were chosen for 3 cases;areola incisions were made for 32 cases;alar skin lines incisions were made for 75 cases;the rest 285 cases had axillary midline incisions.Postoperative pathology:there were 299 cases of breast fibroadenoma,47 cases of mammary gland hyperplasia with fibroadenoma sample structure,11 cases of breast intraductal papilloma,26 cases of breast cystic hyperplasia,8 cases of retention cyst of breast,2 cases of severe dysplasia,1 case of intraductal carcinoma and 3 cases of infiltrating ductal carcinoma,including 2 cases of lesions located in the left breast away from the papilla by 1 cm and treated by radical resection of breast cancer,and 1 case of the mass in the right breast away from the papilla by 3 cm,which underwent breast preserving surgery combined with axillary lymph node dissection.Compared with postoperative pathology,positive predictive value of B ultrasound was 75.0%(3 /4),misdiagnosis rate(false positive) was 0.2%(1 /393),missed diagnosis(false negative) was 25.0%(1 /4) and accuracy was 99.5%(395 /397).The 393 cases of benign lesions were followed up for 6- 24 months,and all of the cases recovered well with hidden incision and good cosmetic results.Conclusion The preferred procedure for patients diagnosed as benign lesions should consider incisions at alar skin lines,axillary midline and areola of mamma;for possible malignant tumor,incisions near lesions should be selected.更多还原