X线导引下乳腺钙化导丝定位活检的应用价值

摘要

背景与目的:钙化是早期乳腺癌最易察觉的征象,X线发现可疑恶性钙化灶可行X线引导下经皮穿刺导丝定位开放活检.本研究探讨乳腺可疑恶性钙化灶X线引导下导丝定位开放活检的应用价值.方法:对32例共37个临床触诊阴性而X线检查发现有可疑恶性钙化灶的患者,行X线引导下导丝定位开放活检术.所有活检切除标本均立即行X线摄片,确定切除是否完全,再送病理学检查.结果:32例患者共37个病灶有7个为恶性,其中5个导管内原位癌(ductal carcinoma in situ,DCIS),2个浸润性导管癌(invasive ductal carcinoma,IDC)；30个良性病灶,其中6个导管内不典型增生(atypical ductal hyperplasia,ADH),14个上皮增生,10个腺病,总的恶性率为18.92％.对DCIS病灶进行了患侧乳腺局部扩大切除乳房保留术,对IDC病灶进行了患侧乳房改良根治术.结论:对临床触诊阴性而X线检查发现的可疑恶性钙化灶应行X线引导下导丝定位开放活检,可提高早期乳腺癌及临床触诊阴性乳腺癌的检出率及诊断率,为患者临床治疗方案的制定提供依据.%Background and purpose: Calcification is the most sensitive sign in early breast cancer, X-ray suspicious malignant calcifications should receive X-ray guided wire localization open biopsy. The purpose of this study was to explore the application value of X-ray guided wire localization open biopsy of breast abnormal calcifications. Methods: 37 lesions in 32 patients with non-palpable abnormal calcifications on mammography underwent X-ray guided wire localization open biopsy in our study. The abnormal calcifications in excited specimen were checked by X-ray again. The preoperative assessment of mammography was reviewed and a correlation with pathological examination of the surgical specimens was reported. Results: A total of 37 wire localization excision biopsies were carried out in 32 female patients. The overall malignancy rate was 18.92% (7/37). Five of these patients were ductal carcinoma in situ (DCIS); 2 were invasive ductal carcinoma (IDC); 6 were atypical ductal hyperplasia (ADH); 14 were epithelial hyperplasia; and 10 were adenosis. Out of 35 lesions which were suspicious lowly malignancy on preoperative assessment, 5 malignancies were found, while in the 2 lesions thought to be highly suggestive of malignancy on preoperative assessment, there were 2 malignancies, giving a sensitivity of 28.57% and a specificity of 100%. The X-ray showed that all lesions were completely resected. 5 patients with DCIS were treated with breast conservation surgery, and 2 patients with invasive ductal carcinoma were treated with modified radical mastectomy. Conclusion: Patients with diagnoses of non-palpable calcifications by mammography should undergo X-ray guided wire localization open biopsy, which can increase the diagnosis rate of early breast cancer and improve the prognosis.