CAJ | 학술논문

目的分析乳腺立体定位核芯针活检的病理组织学低估的原因,以期引起临床多学科的重视及客观对待.方法 2000年9月至2005年9月,对146例乳腺病变患者(179个病变)进行立体定位核芯针病变部位穿刺活检,发生病理组织学低估21个.病变均不可触及(NPBL),根据乳腺影像报告和数据系统(BI.RADS),活检前诊断BI-RADS m类6个,Ⅳ类12个,V类3个,影像表现为钙化16个,肿块2个,不对称性致密1个,星芒征2个.结果活检为纤维囊性乳腺病并导管上皮不典型增生11个,手术诊断为导管原位癌7个,伴早期浸润4个;活检为重度乳腺导管不典型增生3个,手术诊断为原位癌1个,原位癌伴早期浸润2个;活检为乳腺导管原位癌3个,手术证实均为浸润性癌;活检为乳头状病变4个,手术证实为原位癌及伴早期浸润各1个、浸润性导管癌及乳腺导管内乳头状腺癌各1个.结论乳腺核芯针活检的病理组织学低估与立体定位技术、病变本身及医师的认识有关,放射科医师应熟练掌握活检技术并力求全面取材,当穿刺活检结果与影像表现不符时,应重新评价病变的实际病理诊断.
목적 분석유선입체정위핵심침활검적병리조직학저고적원인,이기인기림상다학과적중시급객관대대.방법 2000년9월지2005년9월,대146례유선병변환자(179개병변)진행입체정위핵심침병변부위천자활검,발생병리조직학저고21개.병변균불가촉급(NPBL),근거유선영상보고화수거계통(BI.RADS),활검전진단BI-RADS m류6개,Ⅳ류12개,V류3개,영상표현위개화16개,종괴2개,불대칭성치밀1개,성망정2개.결과 활검위섬유낭성유선병병도관상피불전형증생11개,수술진단위도관원위암7개,반조기침윤4개;활검위중도유선도관불전형증생3개,수술진단위원위암1개,원위암반조기침윤2개;활검위유선도관원위암3개,수술증실균위침윤성암;활검위유두상병변4개,수술증실위원위암급반조기침윤각1개、침윤성도관암급유선도관내유두상선암각1개.결론 유선핵심침활검적병리조직학저고여입체정위기술、병변본신급의사적인식유관,방사과의사응숙련장악활검기술병력구전면취재,당천자활검결과여영상표현불부시,응중신평개병변적실제병리진단.
Objective To analyze the histological underestimation of stereotactic core needle biopsy (SNCB).and tO attract clinicians' attention.Methods SNCB was performed in 146 patients with 179 lesions from September 2000 to June 2005.and 21 lesions were underestimated histologically.0f 21 nonpalpable breast lesions(NPBL).6 lesions were diagnosed as BI-RADS nl,12 8S BI-RADS Ⅳ,3 as BI-RADS V according to BI-RADS before biopsy.Mammography showed 16 lesions with calicification, 2 cases with masses,1 case with asymmetry density and 2 cases with stellate sign.Results Eleven lesions diagnosed as fibrocystic disease with atypical ductal hyperplasia by biopsy were proved to be ductal carcinoma in situ (DCIS)in 7 lesions and early infiltration in 4 lesions by pathology.3 lesions diagnosed as severe atypical hyperplasia by biopsy were finally proved to be 1 carcinoma in situ and early infiltration in 2 lesions by pathology.3 lesions diagnosed as DCIS by biopsy were invasive carcinoma.4 lesions diagnosed papillary lesions by biopsy and finally were 1 carcinoma in situ,1 early infiltration,1 infiltrating ductal carcinoma and l intraductal papillary adenocarcinoma.Conclusion The histological underestimation of SCNB Was related to the stereotactic location technology,lesion and doctor'S understanding,the radiologist should master the biopsy skills.