CAJ | 학술논문

目的：探讨超声引导下空芯针穿刺活检对乳腺浸润性导管癌组织学分级的临床价值。方法：回顾性分析我院就诊的临床病理资料完整的276例患者的资料。共302个病灶，均经超声引导下空芯针穿刺活检，术后病理证实为乳腺浸润性导管癌。每个病灶至少取3针。肿瘤级别的诊断依据是Bloom-Richardson组织学分级法。统计学方法应用科恩卡方检验，评估的内容包括低估率、高估率、不同大小（小肿瘤组：＜1.0cm，中间组：1.0-2.5cm，大肿瘤组：＞2.5cm）病灶的诊断符合率。结果：穿刺活检结果和术后病理结果的总体符合率为72.0%（simPle κ=0.52；95%CI，0.38-0.61），穿刺活检对Grade 3级的诊断符合率89.7%（61/68）， Grade 2级诊断符合率66.7%（120/180），Grade 1级诊断符合率65.8%（25/38）。穿刺活检对浸润性导管癌的总体高估率22.0%，总体低估率5.9%。当肿瘤体积增大时，穿刺活检容易出现较高的低估率，大肿瘤组42.4%，中间组21.9%，小肿瘤组16.0%（P＜0.003）。结论：超声引导下空芯针穿刺活检能够准确预测高级别浸润性乳腺导管癌，肿瘤体积的增大在一定程度上影响了穿刺活检的准确性，造成较高的低估率。
목적：탐토초성인도하공심침천자활검대유선침윤성도관암조직학분급적림상개치。방법：회고성분석아원취진적림상병리자료완정적276례환자적자료。공302개병조，균경초성인도하공심침천자활검，술후병리증실위유선침윤성도관암。매개병조지소취3침。종류급별적진단의거시Bloom-Richardson조직학분급법。통계학방법응용과은잡방검험，평고적내용포괄저고솔、고고솔、불동대소（소종류조：＜1.0cm，중간조：1.0-2.5cm，대종류조：＞2.5cm）병조적진단부합솔。결과：천자활검결과화술후병리결과적총체부합솔위72.0%（simPle κ=0.52；95%CI，0.38-0.61），천자활검대Grade 3급적진단부합솔89.7%（61/68）， Grade 2급진단부합솔66.7%（120/180），Grade 1급진단부합솔65.8%（25/38）。천자활검대침윤성도관암적총체고고솔22.0%，총체저고솔5.9%。당종류체적증대시，천자활검용역출현교고적저고솔，대종류조42.4%，중간조21.9%，소종류조16.0%（P＜0.003）。결론：초성인도하공심침천자활검능구준학예측고급별침윤성유선도관암，종류체적적증대재일정정도상영향료천자활검적준학성，조성교고적저고솔。
Objective:To evaluate the clinical value of ultrasound-guided core bioPsy diagnosing tumor grade of invasive ductal carcinoma of the breast. Methods:We retrosPectively studied 302 consecutive invasive ductal carcino-mas(276 women)who were bioPsied under ultrasound-guided,core needles exclusively. Core bioPsy grades were comPared with final surgical grades. The correlation between tumor size(small,<1. 0cm;medium,1. 0-2. 5cm;and large,>2. 5cm)and agreement rate was evaluated. Results:The overall agreement between core bioPsy and surgical Pathology grade was 72. 0%(simPle κ=0. 52;95%CI,0. 38-0. 61). Agreement by bioPsy grade was 89. 7%(61/68)for grade 3,66. 7%(120/180)for grade 2,and 65. 8%(25/38)for grade 1. Core bioPsy overestimated 22. 0%(63/286)and underestimated 5. 9%(17/286)of the lesions. When tumors is larger,they were more likely to show underestimation,42. 4% for large,21. 9% for medium,and 16. 0% for small tumor(P<0. 003). Conclusion:Ultra-sound-guided core bioPsy accurately Predicts high-grade breast tumors. Large tumor size imPacts the accuracy of tumor grade found on bioPsy and is result to underestimation.