乳腺病变超声引导下空芯针穿刺活检诊断价值的临床研究

发布时间：2018-05-21 21:37

本文选题：乳腺 + 空芯针　；参考：《中国人民解放军医学院》2014年博士论文

【摘要】：目的 1.探讨两种不同直径空芯针对不同声像学特征的乳腺病灶行超声引导穿刺活检的准确性。 2.评估超声引导穿刺活检诊断乳腺病变所致的组织病理学低估率。材料与方法 1.回顾性分析2005年7月至2012年7月在中国人民解放军总医院超声科行超声引导下16G及18G空芯针乳腺穿刺活检共4,453例，随后外科手术切除的病例955例。超声引导穿刺活检病理结果与手术切除病理结果对比，根据穿刺针内径和病变的声像学特征分组分析穿刺活检的符合率、敏感性、假阴性率。 2.（1）回顾性分析2005年7月至2012年7月在中国人民解放军总医院超声科行穿刺活检的超声可视乳腺病灶4,453例，其中，955例随后外科手术切除，其超声引导穿刺活检病理结果与手术切除病理结果对比，分析超声引导穿刺活检诊断的组织病理学低估率及低估原因。（2）2005年7月至2012年7月行超声引导乳腺穿刺活检的病例中，经穿刺病理诊断为乳腺乳头状病变207例，随后行外科手术90例，随访大于1年者110例，失访7例。依据美国放射学会（American College of Radiology，ACR）乳腺病灶超声声像学分类（Breast Imaging Reporting and Data System，BI-RADS）及不同穿刺方法分别将穿刺活检病理结果与手术切除病理结果对比，分析乳腺乳头状病变超声引导穿刺活检的病理组织学低估率。结果 1.所有穿刺活检后经外科手术切除的955例病灶中，16G空芯针穿刺566例，18G空芯针穿刺389例。穿刺活检病理结果中，，恶性占84.1%，高危占8.4%，良性占7.5%。16G及18G穿刺活检与术后病理的总符合率分别为92.4%及92.8%；完全敏感性（1-假阴性率）、绝对敏感性（所有手术结果为恶性的病例中超声引导空芯针穿刺活检正确诊断的比率）及假阴性率均分别为98.6%，93.9%及1.4%。对于16G及18G空芯针穿刺活检，肿块型病灶的穿刺符合率(16G:92.7%;18G:93.7%)均明显高于非肿块型病灶(16G,85.7%;18G,78.3%))(其中，应用18G空芯针穿刺活检P0.01)；对于直径小于等于10mm的肿块型病灶穿刺的符合率(16G,83.3%;18G,86.7%)明显低于总符合率(P0.01)。含钙化病灶与不含钙化病灶间的穿刺符合率无统计学差异（P0.01）。 2.（1）955例乳腺穿刺活检病例中，共有123例病灶被低估。高危低估率及导管内癌低估率分别为16G：48.0%及46.2%；18G：53.3%及41.2%。两种穿刺方法间的低估率无统计学差异（P0.01）。其中，高危病灶低估中又以非典型增生低估率最高，占所有高危低估的52.5%。（2）90例术前诊断为乳头状病变、随后行手术切除的病灶中，术后病理组织学低估共29例(32.2%），恶性低估22例（24.4%）。23例导管内乳头状瘤伴非典型增生的病灶中，11例（47.8%）被低估。137例穿刺病理为良性且病理影像学相符的病灶中，8例（5.8%）被低估。25例穿刺病理为良性但病理影像学不符的病灶中，10例被低估（40%）。18G、16G空芯针穿刺活检的组织学低估率分别为17.9%（P=0.017）、16.0%（P=0.023），均明显高于真空辅助穿刺活检的0。结论 1.超声引导16G及18G空芯针穿刺活检对于诊断直径大于10mm的肿块型乳腺病灶均是准确的方法。 2.（1）超声引导16G及18G空芯针穿刺活检诊断的高危及导管内癌病变均存在较高的低估率，该类病变需进行进一步真空辅助穿刺活检或外科切除活检来明确诊断。（2）应用真空辅助粗针穿刺活检诊断乳腺乳头状病变的组织学低估率明显低于16G及18G空芯针穿刺活检。对于穿刺活检诊断的病理影像学相符的良性导管内乳头状瘤可以临床随访，而穿刺病理为乳头状病变伴非典型增生或病理影像学不符的良性导管内乳头状瘤，真空辅助粗针穿刺活检或外科手术切除来明确诊断是必要的。
[Abstract]:Purpose

1 . To investigate the accuracy of ultrasound - guided puncture biopsy in breast lesions with different diameters and different diameters .

2 . To evaluate the rate of histopathological evaluation in the diagnosis of breast lesions by ultrasound - guided puncture biopsy .

Materials and Methods

1 . From July 2005 to July 2012 , a total of 4,453 cases of 16G and 18G empty core needle biopsy were performed under ultrasound guidance in the General Hospital of the Chinese People ' s Liberation Army ( PLA ) .

2 . ( 1 ) From July 2005 to July 2012 , there were 4,453 cases of ultrasound - visible breast lesions in the General Hospital of the Chinese People ' s Liberation Army ( PLA General Hospital ) . Among them , 955 cases were followed by surgical resection , and the pathological results of ultrasound - guided puncture biopsy were compared with the pathological results of surgical resection .

( 2 ) From July 2005 to July 2012 , 207 patients with breast papillary lesions were diagnosed as breast papillary lesions , followed by surgical operation in 90 cases , follow - up for more than 1 year , 110 cases , and follow - up of 7 cases . According to American College of Radiation ( ACR ) breast lesions : Breast Imaging Reporting and Data System ( BI - RADS ) and different puncture methods , the pathological results of puncture biopsy were compared with the pathological results of surgical resection respectively .

Results

1 . Of the 955 lesions , 16G hollow needle aspiration 566 cases , 18G hollow needle aspiration 389 cases were performed after all puncture biopsy . Among the pathological results of puncture biopsy , 84.1 % , 8.4 % , 7.5 % , 16G and 18G biopsy and postoperative pathology were 92.4 % and 92.8 % , respectively .
Complete sensitivity ( 1 - false negative rate ) , absolute sensitivity ( ratio of ultrasound - guided empty - core needle aspiration biopsy in malignant cases ) and false - negative rate were 98 . 6 % , 93 . 9 % and 1.4 % , respectively .
The compliance rate ( 16G , 83.3 % , 18G , 86.7 % ) was significantly lower than the total coincidence rate ( P0.01 ) . There was no statistical difference between calcified lesions and calcified lesions ( P0.01 ) .

2 . ( 1 ) Of the 955 cases of breast biopsy , 123 cases were underestimated . The rate of high - risk undervaluation and the rate of underestimation of intraductal carcinoma were 16G : 48.0 % and 46.2 % , respectively .
18G : 53 . 3 % and 41.2 % . There was no statistical difference between the two kinds of puncture methods ( P0.01 ) . Among them , the high - risk lesion was underestimated and the rate of atypical hyperplasia was the highest , accounting for 52.5 % of all the high - risk understates .

( 2 ) Of the lesions that were diagnosed as papillary lesions before operation , 29 ( 32 . 2 % ) were underrated and 22 ( 24 . 4 % ) were moderately underestimated . Of the 23 lesions with atypical hyperplasia , 11 cases ( 5.8 % ) were underestimated . Of them , 10 were underestimated ( 40 % ) . In 18 G , 16 G empty core needle biopsy , the rate of histology was 17.9 % ( P = 0 . 017 ) and 16.0 % ( P = 0.023 ) , respectively , which were significantly higher than those of vacuum assisted puncture biopsy .

Conclusion

1 . Ultrasound guided 16G and 18G needle aspiration biopsy are accurate methods for the diagnosis of mass - type breast lesions with diameters greater than 10mm .

2 . ( 1 ) There is a high rate of underestimation of the high risk of intraductal carcinoma of the catheter by ultrasound - guided 16G and 18G needle aspiration biopsy , and further vacuum - assisted puncture biopsy or surgical resection of biopsy is required for the diagnosis .

( 2 ) The histological evaluation rate of breast papillary lesion was significantly lower than that of 16G and 18G hollow needle biopsy in the diagnosis of breast papillary lesions by vacuum assisted coarse needle aspiration biopsy .
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R445.1;R737.9

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