术前乳腺X线引导下导丝穿刺定位在乳腺钙化灶诊疗中的应用
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摘要
目的探讨术前乳腺X线引导下行导丝穿刺定位切除乳腺钙化灶在乳腺疾病诊疗中的临床应用价值。方法对63例乳腺病患者,临床触诊阴性、彩超阴性但乳腺X线摄片发现异常表现的钙化病灶,术前行乳腺X线导丝穿刺定位,术中病灶切除活检,确定病灶的病理类型。结果 63例异常钙化灶病例中,浸润性乳腺癌11例(17.5%)、乳腺导管原位癌6例(9.5%)、不典型增生13例(20.6%)、乳腺纤维腺瘤28例(44.4%)、其他良性病变5例(7.9%)。并且病理结果与钙化灶的形态与分布特点具有相关性,表现为不定形、不均质、成簇分布或线样分支状的钙化灶提示恶性程度高,需要临床进一步活检或者手术治疗。结论乳腺X线引导下导丝穿刺定位切除钙化灶具有组织创伤小,定位准确,安全可靠等特点,提高乳腺癌的早期诊断,对改善乳腺癌患者的预后和生存有重要意义。
Objective To investigate the clinical application value of preoperative breast X-ray guided percutaneous needle aspiration biopsy in the diagnosis and treatment of breast calcification. Methods Sixty-three cases of breast disease patients who were negative in clinical palpation,and negative in Color Doppler ultrasound examination but mammography found abnormal calcification lesion in the breast were enrolled in the experiment,preoperative breast X-ray guided percutaneous needle aspiration biopsy were conducted,then the focus was removed during the operation to determine of the pathologic type. Results Among 63 cases of abnormal calcification ones,11 cases of invasive breast cancer( 17. 5%),6 cases of breast ductal carcinoma in situ( 9. 5%),13 cases of atypical hyperplasia( 20. 6%),28 cases of breast fibroadenoma( 44. 4%) and 5 cases with other benign lesions( 7. 9%). Meanwhile the pathological results were associated with the morphology and distribution of calcification,which suggested a high degree of malignancy of amorphous,heterogeneous,clustered distribution or line like branching calcification,which needed further clinical biopsy or surgical treatment. Conclusion The breast X-ray guided percutaneous needle biopsy is featured with small tissue trauma,accurate positioning,safe and reliable,which could promote the early diagnosis rate of breast cancer. It also has important significance to improve the prognosis and survival of patients with breast cancer.
Objective To investigate the clinical application value of preoperative breast X-ray guided percutaneous needle aspiration biopsy in the diagnosis and treatment of breast calcification. Methods Sixty-three cases of breast disease patients who were negative in clinical palpation,and negative in Color Doppler ultrasound examination but mammography found abnormal calcification lesion in the breast were enrolled in the experiment,preoperative breast X-ray guided percutaneous needle aspiration biopsy were conducted,then the focus was removed during the operation to determine of the pathologic type. Results Among 63 cases of abnormal calcification ones,11 cases of invasive breast cancer( 17. 5%),6 cases of breast ductal carcinoma in situ( 9. 5%),13 cases of atypical hyperplasia( 20. 6%),28 cases of breast fibroadenoma( 44. 4%) and 5 cases with other benign lesions( 7. 9%). Meanwhile the pathological results were associated with the morphology and distribution of calcification,which suggested a high degree of malignancy of amorphous,heterogeneous,clustered distribution or line like branching calcification,which needed further clinical biopsy or surgical treatment. Conclusion The breast X-ray guided percutaneous needle biopsy is featured with small tissue trauma,accurate positioning,safe and reliable,which could promote the early diagnosis rate of breast cancer. It also has important significance to improve the prognosis and survival of patients with breast cancer.
引文
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[2]Moriya T.Diagnosis of non-palpable breast cancer(image-detected breast cancer)[J].Breast Cancer,2005,12(4):249~249.
[3]中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2013版)[J].中国癌症杂志,2013(8):928~930.
[4]Ohnuki K.Mammographic screening for non-palpable breast cancer in Japan[J].Breast Cancer,2005,12(4):258~266.
[5]苏静,陈明勋,李孟圈.钼钯X线引导下导丝定位在乳腺亚临床病灶切除中的应用[J].中华医学杂志,2011,91(2):92~94.
[6]Baker R,Rogers KD,Shepherd N,et al.New relationships between breast microcalcifications and cacer[J].Br J Cancer,2010,103(7):1034~1039.
[7]徐莉,张刚,刘园园,等.浸润性导管癌钼靶X线征象:高密度与等密度肿块比较[J].实用医学杂志,2013,29(3):377~380.
[8]林少毓,蒋飞宇,陈玲.数字化钼靶X线摄影与彩色多普勒超声对乳腺良恶性肿块的诊断价值[J].吉林医学,2014(15):3313~3313.
[9]Zujewski JA,Harlan LC,Morrell DM,et al.Ductal carcinoma in situ:trends in treatment over time in the US[J].Breast Cancer Res&Treat,2011,127(1):251~257.
[10]朱思吉,吴佳毅,陈伟国.乳腺小叶原位癌外科治疗进展[J].中国实用外科杂志,2013,33(3):230~233.
[11]王颀,连臻强.乳腺癌早期诊断的临床思路[J].中华乳腺病杂志:电子版,2010,4(4):357~360.
[12]李春艳,侯国芳,张晟,等.乳腺导管内癌治疗方式研究进展[J].中国老年学杂志,2013,33(4):963~966.
[13]胡大章,陈华芳,周雪梅.钼靶下细针穿刺定位在微小乳腺癌诊治中的作用[J].介入放射学杂志,2006,15(12):760~762.