CAJ | 학술논문

目的评价真空辅助旋切活检和金属丝定位活检对不能触及的乳腺病灶(NPBL)诊断的准确性和有效性.方法将97例NPBL患者随机分为两组,分别行金属丝定位切除活检(48例)和真空辅助旋切活检(49例),活检标本均经钼靶确认.记录真空辅助活检组对不典型增生和导管原位癌的低估率以及切缘.对术后的乳房美容效果及术后第1天疼痛强度进行评分.结果两组患者均成功活检,真空辅助旋切活检组的标本大小为2.3 cm3,显著小于金属丝定位切除活检组(18.4cm3,P=0.03).真空辅助活检组对不典型增生和导管原位癌的低估率分别为16.7%和11.1%.真空辅助旋切活检组的诊断符合率为97.9%,假阴性率为2.1%,无假阳性病例.真空辅助旋切活检组手术后第1天疼痛评分为1.7,低于金属丝定位切除活检组(2.5,P=0.02).真空辅助旋切活检组术后美容评分优良40例,良好8例;金属丝定位切除活检组优良25例,良好24例,两组差异有统计学意义(P<0.05).结论真空辅助旋切活检结果可靠,可使大部分良性病变患者免于开放手术,但由于组织学诊断的低估以及较高的切缘阳性率,真空辅助旋切活检尚不能完全替代金属丝定位活检.
목적 평개진공보조선절활검화금속사정위활검대불능촉급적유선병조(NPBL)진단적준학성화유효성.방법 장97례NPBL환자수궤분위량조,분별행금속사정위절제활검(48례)화진공보조선절활검(49례),활검표본균경목파학인.기록진공보조활검조대불전형증생화도관원위암적저고솔이급절연.대술후적유방미용효과급술후제1천동통강도진행평분.결과 량조환자균성공활검,진공보조선절활검조적표본대소위2.3 cm3,현저소우금속사정위절제활검조(18.4cm3,P=0.03).진공보조활검조대불전형증생화도관원위암적저고솔분별위16.7%화11.1%.진공보조선절활검조적진단부합솔위97.9%,가음성솔위2.1%,무가양성병례.진공보조선절활검조수술후제1천동통평분위1.7,저우금속사정위절제활검조(2.5,P=0.02).진공보조선절활검조술후미용평분우량40례,량호8례;금속사정위절제활검조우량25례,량호24례,량조차이유통계학의의(P<0.05).결론 진공보조선절활검결과 가고,가사대부분량성병변환자면우개방수술,단유우조직학진단적저고이급교고적절연양성솔,진공보조선절활검상불능완전체대금속사정위활검.
Objective To compare the effectiveness and accuracy of the use of vacuum-assisted biopsy ( VAB) versus wire localization ( WL) in the diagnosis of non-palpable breast lesions ( NPBL). Methods Ninety-seven consecutive women with NPBL were randomized into VAB group and WL group.All specimens were identified by mammography. The patients were requested to score the cosmetic appearance of their breast after operation, and a numerical rating scale was used to measure pain on the first postoperative day. Underestimation rates for atypical ductal hyperplasia ( ADH) and ductal carcinoma in situ ( DCIS) were recorded if open surgical biopsy revealed DCIS and invasive cancer, respectively. Clear margins were also recorded in the two groups.Results VAB and WL located all the NPBL successfully. In the VAB group, the specimen volume was smaller than that of the WL group (2.3 cm3 vs. 18. 4 cm3, P = 0. 03). Underestimation rates of ADH and DCIS in the VAB group were 16. 7% and 11. 1% , respectively. The diagnostic accordance rate of VAB was 97. 9% , the false negative rate was 2. 1% , and there was no false positive case. The means of the numerical rating pain scale were different in both groups (1.7 for VAB vs. 2.5 for WL, P =0. 02).When cosmetic results were taken into account, 40 VAB patients had excellent outcomes and 8 good outcomes, compared with 23 excellent and 24 good for the WL group. There were better cosmetic outcomes with the VAB procedure ( P < 0.05). Conclusion VAB is highly reliable and may avoid diagnostic open surgery in the majority of patients with benign lesions. However, because of the underestimation of histologic diagnosis and tumor margin involvement, VAB can not be used to completely substitute wire localization.