CAJ | 학술논문

目的：评价影像引导真空辅助空心针乳腺穿刺活检（ vacuum-assisted breast biopsy，VAB）在诊断乳腺微钙化中的临床应用价值。方法2012年12月～2014年8月，对42例钼靶诊断乳腺微钙化行VAB，美国放射学会乳腺影像报告与诊断系统（ BI-RADS）分级3级5例，4级34例，5级3例。其中31例钼靶引导，11例超声引导。结果42例活检标本在影像上都能观察到钙化灶并经病理证实，24例簇状钙化灶完全切除，2例簇状及16例非簇状钙化灶部分切除。病理诊断导管原位癌13例，浸润性导管癌5例，浸润性小叶癌1例，均行手术治疗，其余23例病理为良性。钼靶微钙化及超声微钙化诊断乳腺癌的阳性预测值分别为45．2％（19／42）及70．0％（14／20）（χ2＝3．337，P＝0．068）。超声微钙化诊断乳腺癌的阴性预测值为77．3％（17／22）。术后并发症包括穿刺部位渗血1例，皮下瘀斑4例。随访时间6～26个月，平均13个月。19例乳腺癌均无复发，23例良性患者切口愈合良好，乳房外观满意，未发现恶性肿瘤。结论钼靶能发现超声不能发现的乳腺微钙化灶，钼靶及超声发现的乳腺微钙化灶在乳腺癌的诊断中有重要价值，VAB诊断乳腺微钙化准确，微创，术后并发症少。
목적：평개영상인도진공보조공심침유선천자활검（ vacuum-assisted breast biopsy，VAB）재진단유선미개화중적림상응용개치。방법2012년12월～2014년8월，대42례목파진단유선미개화행VAB，미국방사학회유선영상보고여진단계통（ BI-RADS）분급3급5례，4급34례，5급3례。기중31례목파인도，11례초성인도。결과42례활검표본재영상상도능관찰도개화조병경병리증실，24례족상개화조완전절제，2례족상급16례비족상개화조부분절제。병리진단도관원위암13례，침윤성도관암5례，침윤성소협암1례，균행수술치료，기여23례병리위량성。목파미개화급초성미개화진단유선암적양성예측치분별위45．2％（19／42）급70．0％（14／20）（χ2＝3．337，P＝0．068）。초성미개화진단유선암적음성예측치위77．3％（17／22）。술후병발증포괄천자부위삼혈1례，피하어반4례。수방시간6～26개월，평균13개월。19례유선암균무복발，23례량성환자절구유합량호，유방외관만의，미발현악성종류。결론목파능발현초성불능발현적유선미개화조，목파급초성발현적유선미개화조재유선암적진단중유중요개치，VAB진단유선미개화준학，미창，술후병발증소。
Objective To evaluate the clinical value of image-guided vacuum-assisted breast biopsy in the diagnosis of breast microcalcifications. Methods From December 2012 to August 2014, image-guided vacuum-assisted breast biopsy was used in 42 patients with breast microcalcifications diagnosed by mammography .According to American College of Radiology Breast Imaging-Reporting and Data System (BI-RADS), there were 5 cases of BI-RADS category 3, 34 cases of BI-RADS category 4, and 3 cases of BI-RADS category 5.During breast biopsy , 31 were guided by mammography and 11 were guided by ultrasound . Results In the 42 patients, calcium was visualized by an X-ray of the biopsy specimen , and calcification was reported histopathologically .Twenty-four lesions appeared as clustered calcifications were completely removed , and 2 lesions appeared as clustered calcifications and other lesions were partly removed .Pathological diagnosis showed 13 cases of ductal carcinoma in situ , 5 cases of infiltrating ductal carcinoma , 1 case of infiltrating lobular carcinoma , and 23 cases of benign lesions .All the patients diagnosed as breast cancer received operation.The positive predictive values of microcalcifications detected by mammography and by ultrasound in the diagnosis of breast cancer were 45.2% (19/42) and 70.0% (14/20), respectively (χ2 =3.337,P =0.068).The negative predictive value of microcalcifications detected by ultrasound in the diagnosis of breast cancer was 77.3% (17/22).One patient suffered bleeding at puncture site, and ecchymosis was observed in 4 patients.The average follow-up period was 13 months (range, 6-26 months).No recurrence was found in 19 breast cancer patients .Among the 23 patients with benign lesions , the incision healed well , the appearance of breast was satisfactory , and no signs of malignancy were seen . Conlusions Mammography can detect breast microcalcifations that can’ t be detected by ultrasound .Breast microcalcifations detected by mammography and ultrasound has great value in the diagnosis of breast cancer .Image-guided vacuum-assisted breast biopsy is accurate , minimally invasive , and safe in the diagnosis of breast microcalcifications .