乳腺可疑微钙化灶金属标记夹放置的筛选条件及近期移位的影响因素

摘要

Objective To analyze the indications of clip deployment and influencing factors for clip dislocation immediately after stereotactic vacuum-assisted breast biopsy. Methods One hundred and fourteen microcalcifications in 108 women aged 35 to 85 years old (median 63 years) underwent 11-gauge stereotactic vacuum-assisted breast biopsy. Every lesion was marked on biopsy site with Gel Mark Ultra clips (n = 82) or MicroMark Ⅱ clips ( n = 32) after biopsy. All microcalcifications were classified 3 mono-focal groups: < 10 mm, 10--20 mm, > 20 mm and one muhi-focal group according to its diameter and distribution. The distances between clips and biopsy sites were directly measured on post-biopsy craniocaudal and mediolateral mammograms. The distance was recorded as < 10 mm, 10--20 mm and >20 mm. Results 88% (22/25) of mono-focal microcalcifications smaller than 10 mm and 70% (14/20) of mono-focal microcalcifications measured 10--20 mm were completely removed on mammograms, whereas none of mono-focal microcalcifications larger than 20 mm (n = 17) was completely removed. 65.8% (75/114) of the clips were accurately located. Thirty-nine clips were dislocated on at least one projection with 87.2% (34/39) of the clips dislocated only along the needle track, which is called "accordion effect". Hematoma was found in 4 patients, and the clip was accurately localized only in one case with hematoma, Conclusions Clips should be deployed as a standard procedure for mono-focal microcalcifications smaller than 20 mm and all multi-focal mierocalcifications. The major reasons for clip dislocation immediately after biopsy are the accordion effect and hematoma.%目的 探讨乳腺微钙化灶活检过程中放置金属标记夹的筛选条件和影响标记夹移位的因素.方法 108例患者中的114处乳腺微钙化灶做了11 G真空辅助立体定位活检.活检后在每一处病灶都放置了标记央,采用Gel Mark Ultra(82处)或MicroMark Ⅱ标记央(32处).所有钙化簇按照直径和(或)分布被划分成直径<10、10～20、>20 mm的单簇和多簇钙化,并判断金属夹放置的筛选条件.在乳腺X线片上直接测量标记夹和活检部位的距离,按照<10、10～20、>20 mm分成3组.结果 直径<10 mm(25例)和直径10～20 mm之间的单簇钙化(20例)中分别有88.0%(22例)和70.0%(14例)的病灶在活检后显示钙化被取净,直径>20 mm的单簇钙化(17例)没有病灶能被取净.65.8%(75/114)的标记夹准确定位,39个标记夹发生移位,其中34个(87.2%)是沿针道移位,即"手风琴效应"移位.4例患者在活检部位发生大血肿,其中只有1例标记夹能准确定位.结论 直径<20 mm的单簇钙化及多簇钙化灶在活检后都需要放置标记夹,只有直径>20 mm的单簇钙化不需要放置.影响标记夹近期移位的主要因素是"手风琴效应"和血肿.