真空辅助活检对空心针活检病理结果与超声诊断存在差异的乳腺占位性病变的诊断研究

摘要

目的:评价在空心针活检(core needle biopsy,CNB)病理结果与超声诊断存在差异的乳腺占位性病变中,真空辅助活检(vacuum-assisted biopsy,VAB)是否可获得准确的病理结果,产生病理升级.材料和方法:2007-01～2008-06,对接受16G CNB的969例患者的1 069个病灶进行超声诊断及穿刺病理分析.其中,28个病灶超声诊断为可疑恶性,但CNB活检得到非恶性结果,采用真空辅助活检系统再次活检.所有VAB证实为良性的病灶均需要临床随访1年以上,所有VAB证实为恶性的病灶均需与手术病理对比分析.结果:本组中,28个病灶的CNB病理诊断与超声诊断存在差异,占2.6%(28/1069).28个病灶中,VAB再次活检证实6个病灶存在病理升级,占21.4%(6/28).其中,1例由腺病升级为导管内癌(ductal carcinoma in situ,DCIS),1例由腺病升级为浸润性导管癌(infitrating ductal carcinoma,IDC),1例由不典型导管增生(atypical ductal hyperplasia,ADH)升级为IDC,2例由导管内乳头状瘤升级为DCIS,1例由硬化性腺病升级为浸润性小叶癌(infiltrating lobular carcinoma,ILC).结论:真空辅助活检系统的出现,大大提高了样本的取材量,提高了诊断的准确性.其在评价CNB与超声诊断存在差异的病例中可获得更为准确的病理结果,产生病理升级.%Purpose To evaluate if re-biopsy with 10-gauge vacuum-assisted biopsy (VAB) could get definitive diagnosis for breast lesions with ultrasound (US) Imaging-histologic discordance at 16-gauge core needle biopsy (CNB). Materials and Methods From January 2007 to June 2008, a consecutive biopsy was performed on 1069 lesions with ultrasound-guided 16-gauge CNB. 28 lesions were considered to be ultrasound imaging-histologic discordant and all of them underwent subsequent 10-gauge VAB. All malignant lesions at VAB got subsequent surgery and all benign lesions at VAB with follow up for at least one year. Results Of the 1669 lesions, 28 (21.4％) with imaging-histologic discordance. Six of the 28 lesions (21. 4％) had pathologic upgrade after VAB: One case of adenosis was upgraded to ductal carcinoma in situ (DCIS); 1 case of adenosis was upgraded to infiltrating ductal carcinoma (IDC) ; 1 case of atypical ductal hyperplasia (ADH) was upgraded to IDC; 2 cases of intraductal papilloma were upgraded to DCIS and 1 case of sclerosing adenosis was upgraded to invasive lobular carcinoma (ILC). The subsequent surgery further demonstrated the diagnosis of VAB for all the lesions with histologic upgrade. Conclusion Re-biopsy increased the sample volume taken during breast biopsy and improved diagnostic accuracy. 10-gauge VAB was a valuable method to perform re-biopsy for lesions with imaging-histologic discordance during CNB.