目的探讨空芯针穿刺活组织检查( CNB)与传统的开放性手术活组织检查( OSB)对乳腺癌患者DFS的影响,同时评估两种活组织检查(简称活检)方式对乳腺癌手术质量的影响。方法回顾性分析2007年1月至2009年12月在广东省妇幼保健院乳腺病中心经CNB或OSB证实为乳腺癌的306例患者的临床资料,其中OSB组155例,CNB组151例。采用Kaplan-meier法对两组患者的DFS情况进行分析,并运用Cox回归模型探讨影响乳腺癌患者DFS的因素。同时以保留乳房率、保留乳房患者首次切缘阳性率、前哨淋巴结活检率及手术次数为指标,评价两种活检方式对乳腺癌手术质量的影响；计数资料比较采用χ2检验,计量资料比较采用t检验。结果全部患者的临床随访时间为29~83个月,中位随访时间为59个月。 OSB组与CNB组中出现复发或转移的患者为分别为32例(20.6%,32/155)和29例(19.2%,29/151)。并且,OSB组局部复发率为4.5%(7/155),远处转移率为16.1%(25/155)；CNB组局部复发率为2.6%(4/151),远处转移率为16.5%(25/151)。两组患者间局部复发率及远处转移率的差异均无统计学意义(χ2=0.769、0.010,P=0.380、0.919)。 Kaplan-meier生存分析显示,OSB组与CNB组间DFS差异无统计学意义(χ2=0.030,P=0.864)。 Cox回归分析显示,淋巴结转移、ER及HER-2表达是影响乳腺癌患者DFS的主要因素(OR=2.458,95%CI：1.883~3.209,P=0.000；OR=0．453,95%CI：0.238~0.863,P=0.016；OR=2.086,95%CI：1.110~3.920,P=0.022),不同的活检方式并不影响乳腺癌患者的DFS。 CNB 组的保留乳房率明显高于 OSB 组[25.2%(38/151)比9.7%(15/155),χ2=12．812,P=0.000],手术次数明显少于OSB组(1.00±0.00比1.35±0．48,t=9.090,P=0．000),但其前哨淋巴结活检率与OSB组的相比,差异无统计学意义[31.8%(48/151)比32.9%(51/155),χ2=0.043, P =0.835]。并且,CNB组保留乳房患者的首次切缘阳性率与OSB组的保留乳房患者相比,差异也无统计学意义[10.5%(4/38)比5/15,χ2=2.515,P =0.113]。结论术前空芯针穿刺活检对患者的DFS无不良影响,并且可以明确诊断及分子分型,有利于手术方案及后续辅助治疗方案的制定,尽而提高乳腺癌的手术质量,不失为可扪及肿块乳腺癌的首选活检方法。
目的探討空芯針穿刺活組織檢查( CNB)與傳統的開放性手術活組織檢查( OSB)對乳腺癌患者DFS的影響,同時評估兩種活組織檢查(簡稱活檢)方式對乳腺癌手術質量的影響。方法迴顧性分析2007年1月至2009年12月在廣東省婦幼保健院乳腺病中心經CNB或OSB證實為乳腺癌的306例患者的臨床資料,其中OSB組155例,CNB組151例。採用Kaplan-meier法對兩組患者的DFS情況進行分析,併運用Cox迴歸模型探討影響乳腺癌患者DFS的因素。同時以保留乳房率、保留乳房患者首次切緣暘性率、前哨淋巴結活檢率及手術次數為指標,評價兩種活檢方式對乳腺癌手術質量的影響；計數資料比較採用χ2檢驗,計量資料比較採用t檢驗。結果全部患者的臨床隨訪時間為29~83箇月,中位隨訪時間為59箇月。 OSB組與CNB組中齣現複髮或轉移的患者為分彆為32例(20.6%,32/155)和29例(19.2%,29/151)。併且,OSB組跼部複髮率為4.5%(7/155),遠處轉移率為16.1%(25/155)；CNB組跼部複髮率為2.6%(4/151),遠處轉移率為16.5%(25/151)。兩組患者間跼部複髮率及遠處轉移率的差異均無統計學意義(χ2=0.769、0.010,P=0.380、0.919)。 Kaplan-meier生存分析顯示,OSB組與CNB組間DFS差異無統計學意義(χ2=0.030,P=0.864)。 Cox迴歸分析顯示,淋巴結轉移、ER及HER-2錶達是影響乳腺癌患者DFS的主要因素(OR=2.458,95%CI：1.883~3.209,P=0.000；OR=0．453,95%CI：0.238~0.863,P=0.016；OR=2.086,95%CI：1.110~3.920,P=0.022),不同的活檢方式併不影響乳腺癌患者的DFS。 CNB 組的保留乳房率明顯高于 OSB 組[25.2%(38/151)比9.7%(15/155),χ2=12．812,P=0.000],手術次數明顯少于OSB組(1.00±0.00比1.35±0．48,t=9.090,P=0．000),但其前哨淋巴結活檢率與OSB組的相比,差異無統計學意義[31.8%(48/151)比32.9%(51/155),χ2=0.043, P =0.835]。併且,CNB組保留乳房患者的首次切緣暘性率與OSB組的保留乳房患者相比,差異也無統計學意義[10.5%(4/38)比5/15,χ2=2.515,P =0.113]。結論術前空芯針穿刺活檢對患者的DFS無不良影響,併且可以明確診斷及分子分型,有利于手術方案及後續輔助治療方案的製定,儘而提高乳腺癌的手術質量,不失為可捫及腫塊乳腺癌的首選活檢方法。
목적탐토공심침천자활조직검사( CNB)여전통적개방성수술활조직검사( OSB)대유선암환자DFS적영향,동시평고량충활조직검사(간칭활검)방식대유선암수술질량적영향。방법회고성분석2007년1월지2009년12월재광동성부유보건원유선병중심경CNB혹OSB증실위유선암적306례환자적림상자료,기중OSB조155례,CNB조151례。채용Kaplan-meier법대량조환자적DFS정황진행분석,병운용Cox회귀모형탐토영향유선암환자DFS적인소。동시이보류유방솔、보류유방환자수차절연양성솔、전초림파결활검솔급수술차수위지표,평개량충활검방식대유선암수술질량적영향；계수자료비교채용χ2검험,계량자료비교채용t검험。결과전부환자적림상수방시간위29~83개월,중위수방시간위59개월。 OSB조여CNB조중출현복발혹전이적환자위분별위32례(20.6%,32/155)화29례(19.2%,29/151)。병차,OSB조국부복발솔위4.5%(7/155),원처전이솔위16.1%(25/155)；CNB조국부복발솔위2.6%(4/151),원처전이솔위16.5%(25/151)。량조환자간국부복발솔급원처전이솔적차이균무통계학의의(χ2=0.769、0.010,P=0.380、0.919)。 Kaplan-meier생존분석현시,OSB조여CNB조간DFS차이무통계학의의(χ2=0.030,P=0.864)。 Cox회귀분석현시,림파결전이、ER급HER-2표체시영향유선암환자DFS적주요인소(OR=2.458,95%CI：1.883~3.209,P=0.000；OR=0．453,95%CI：0.238~0.863,P=0.016；OR=2.086,95%CI：1.110~3.920,P=0.022),불동적활검방식병불영향유선암환자적DFS。 CNB 조적보류유방솔명현고우 OSB 조[25.2%(38/151)비9.7%(15/155),χ2=12．812,P=0.000],수술차수명현소우OSB조(1.00±0.00비1.35±0．48,t=9.090,P=0．000),단기전초림파결활검솔여OSB조적상비,차이무통계학의의[31.8%(48/151)비32.9%(51/155),χ2=0.043, P =0.835]。병차,CNB조보류유방환자적수차절연양성솔여OSB조적보류유방환자상비,차이야무통계학의의[10.5%(4/38)비5/15,χ2=2.515,P =0.113]。결론술전공심침천자활검대환자적DFS무불량영향,병차가이명학진단급분자분형,유리우수술방안급후속보조치료방안적제정,진이제고유선암적수술질량,불실위가문급종괴유선암적수선활검방법。
Objective To investigate the impact of core needle biopsy ( CNB ) and traditional open surgical biopsy ( OSB) on disease-free survival and surgical quality of breast cancer patients. Methods We retrospectively analyzed the clinical data of 306 patients with breast cancer diagnosed by CNB or OSB in Breast Disease Center,Guangdong Women and Children’ s Hospital from January 2007 to December 2009,including 155 cases in OSB group and 151 cases in CNB group. Kaplan-meier method was used to analyze disease-free survival in the two groups and Cox regression model was used to discuss the factors influencing the prognosis of the patients. Meanwhile the impact of different biopsy methods on the quality of breast cancer surgery was <br> evaluated by the following parameters:breast-conserving rate, rate of positive margin in first breast-conserving surgery,rate of sentinel lymph node biopsy and times of surgeries. Count data were analyzed by Chi-square test, measurement data by t test. Results All the patients were followed up for 29 to 83 months ( median 59 months). Overall 32 cases(20. 6%,32/155) in OSB group and 29 cases(19. 2%,29/151) in CNB group had recurrence or metastasis. The local recurrence rate and distant metastasis rate was 4. 5% (7/155) and 16. 1%(25/155) in OSB group,2. 6% (4/151) and 16. 5% (25/151) in CNB group,which indicated no significant difference between the two groups (χ2 =0. 769,0. 010,P=0. 380,0. 919). Kaplan-meier survival analysis showed that there was no significant difference in disease-free survival between the two groups (χ2=0. 030,P=0. 864). Cox regression analysis showed that lymph node metastasis,ER and HER-2 expression were the major influencing factors in the prognosis of breast cancer patients ( OR=2. 458, 95%CI:1. 883-3. 209,P=0. 000;OR=0. 453,95%CI:0. 238-0. 863,P=0. 016;OR=2. 086,95%CI:1. 110-3. 920,P=0. 022),and the different methods of biopsy did not affect the disease-free survival. The breast-conserving rate was significantly higher in CNB group than that in OSB group [25. 2%(38/151) vs 9. 7%(15/155),χ2=12. 812,P =0. 000], and the patients in CNB group had fewer operations compared with OSB group (1. 00±0. 00 vs 1. 35±0. 48,t=9. 090,P=0. 000),but there was no significant difference in the rate of sentinel lymph node biopsy between the two groups [31. 8%(48/151) vs 32. 9%(51/155),χ2=0. 043,P=0. 835]. The rate of positive margin in first breast-conserving surgery showed no significant difference between CNB group and OSB group [10. 5% (4/38) vs 5/15,χ2=2. 515,P =0. 113]. Conclusion Preoperative CNB can provide guidance for the diagnosis, molecular typing and the selection of surgical and subsequent adjuvant treatment plans so as to improve the quality of breast cancer surgery,without adverse effects on disease-free survival of breast cancer patients,which can be regarded as the first choice for the patients with palpable breast mass.
