本文選題：乳腺 + 空芯針�。� 參考：《中國人民解放軍醫(yī)學院》2014年博士論文

【摘要】：目的 1.探討兩種不同直徑空芯針對不同聲像學特征的乳腺病灶行超聲引導穿刺活檢的準確性。 2.評估超聲引導穿刺活檢診斷乳腺病變所致的組織病理學低估率。 材料與方法 1.回顧性分析2005年7月至2012年7月在中國人民解放軍總醫(yī)院超聲科行超聲引導下16G及18G空芯針乳腺穿刺活檢共4,453例，隨后外科手術切除的病例955例。超聲引導穿刺活檢病理結果與手術切除病理結果對比，根據(jù)穿刺針內徑和病變的聲像學特征分組分析穿刺活檢的符合率、敏感性、假陰性率。 2.（1）回顧性分析2005年7月至2012年7月在中國人民解放軍總醫(yī)院超聲科行穿刺活檢的超聲可視乳腺病灶4,453例，其中，955例隨后外科手術切除，其超聲引導穿刺活檢病理結果與手術切除病理結果對比，分析超聲引導穿刺活檢診斷的組織病理學低估率及低估原因。 （2）2005年7月至2012年7月行超聲引導乳腺穿刺活檢的病例中，經(jīng)穿刺病理診斷為乳腺乳頭狀病變207例，隨后行外科手術90例，隨訪大于1年者110例，失訪7例。依據(jù)美國放射學會（American College of Radiology，ACR）乳腺病灶超聲聲像學分類（Breast Imaging Reporting and Data System，BI-RADS）及不同穿刺方法分別將穿刺活檢病理結果與手術切除病理結果對比，分析乳腺乳頭狀病變超聲引導穿刺活檢的病理組織學低估率。 結果 1.所有穿刺活檢后經(jīng)外科手術切除的955例病灶中，16G空芯針穿刺566例，18G空芯針穿刺389例。穿刺活檢病理結果中，，惡性占84.1%，高危占8.4%，良性占7.5%。16G及18G穿刺活檢與術后病理的總符合率分別為92.4%及92.8%；完全敏感性（1-假陰性率）、絕對敏感性（所有手術結果為惡性的病例中超聲引導空芯針穿刺活檢正確診斷的比率）及假陰性率均分別為98.6%，93.9%及1.4%。對于16G及18G空芯針穿刺活檢，腫塊型病灶的穿刺符合率(16G:92.7%;18G:93.7%)均明顯高于非腫塊型病灶(16G,85.7%;18G,78.3%))(其中，應用18G空芯針穿刺活檢P0.01)；對于直徑小于等于10mm的腫塊型病灶穿刺的符合率(16G,83.3%;18G,86.7%)明顯低于總符合率(P0.01)。含鈣化病灶與不含鈣化病灶間的穿刺符合率無統(tǒng)計學差異（P0.01）。 2.（1）955例乳腺穿刺活檢病例中，共有123例病灶被低估。高危低估率及導管內癌低估率分別為16G：48.0%及46.2%；18G：53.3%及41.2%。兩種穿刺方法間的低估率無統(tǒng)計學差異（P0.01）。其中，高危病灶低估中又以非典型增生低估率最高，占所有高危低估的52.5%。 （2）90例術前診斷為乳頭狀病變、隨后行手術切除的病灶中，術后病理組織學低估共29例(32.2%），惡性低估22例（24.4%）。23例導管內乳頭狀瘤伴非典型增生的病灶中，11例（47.8%）被低估。137例穿刺病理為良性且病理影像學相符的病灶中，8例（5.8%）被低估。25例穿刺病理為良性但病理影像學不符的病灶中，10例被低估（40%）。18G、16G空芯針穿刺活檢的組織學低估率分別為17.9%（P=0.017）、16.0%（P=0.023），均明顯高于真空輔助穿刺活檢的0。 結論 1.超聲引導16G及18G空芯針穿刺活檢對于診斷直徑大于10mm的腫塊型乳腺病灶均是準確的方法。 2.（1）超聲引導16G及18G空芯針穿刺活檢診斷的高危及導管內癌病變均存在較高的低估率，該類病變需進行進一步真空輔助穿刺活檢或外科切除活檢來明確診斷。 （2）應用真空輔助粗針穿刺活檢診斷乳腺乳頭狀病變的組織學低估率明顯低于16G及18G空芯針穿刺活檢。對于穿刺活檢診斷的病理影像學相符的良性導管內乳頭狀瘤可以臨床隨訪，而穿刺病理為乳頭狀病變伴非典型增生或病理影像學不符的良性導管內乳頭狀瘤，真空輔助粗針穿刺活檢或外科手術切除來明確診斷是必要的。
[Abstract]:Purpose

1 . To investigate the accuracy of ultrasound - guided puncture biopsy in breast lesions with different diameters and different diameters .

2 . To evaluate the rate of histopathological evaluation in the diagnosis of breast lesions by ultrasound - guided puncture biopsy .

Materials and Methods

1 . From July 2005 to July 2012 , a total of 4,453 cases of 16G and 18G empty core needle biopsy were performed under ultrasound guidance in the General Hospital of the Chinese People ' s Liberation Army ( PLA ) .

2 . ( 1 ) From July 2005 to July 2012 , there were 4,453 cases of ultrasound - visible breast lesions in the General Hospital of the Chinese People ' s Liberation Army ( PLA General Hospital ) . Among them , 955 cases were followed by surgical resection , and the pathological results of ultrasound - guided puncture biopsy were compared with the pathological results of surgical resection .

( 2 ) From July 2005 to July 2012 , 207 patients with breast papillary lesions were diagnosed as breast papillary lesions , followed by surgical operation in 90 cases , follow - up for more than 1 year , 110 cases , and follow - up of 7 cases . According to American College of Radiation ( ACR ) breast lesions : Breast Imaging Reporting and Data System ( BI - RADS ) and different puncture methods , the pathological results of puncture biopsy were compared with the pathological results of surgical resection respectively .

Results

1 . Of the 955 lesions , 16G hollow needle aspiration 566 cases , 18G hollow needle aspiration 389 cases were performed after all puncture biopsy . Among the pathological results of puncture biopsy , 84.1 % , 8.4 % , 7.5 % , 16G and 18G biopsy and postoperative pathology were 92.4 % and 92.8 % , respectively .
Complete sensitivity ( 1 - false negative rate ) , absolute sensitivity ( ratio of ultrasound - guided empty - core needle aspiration biopsy in malignant cases ) and false - negative rate were 98 . 6 % , 93 . 9 % and 1.4 % , respectively .
The compliance rate ( 16G , 83.3 % , 18G , 86.7 % ) was significantly lower than the total coincidence rate ( P0.01 ) . There was no statistical difference between calcified lesions and calcified lesions ( P0.01 ) .

2 . ( 1 ) Of the 955 cases of breast biopsy , 123 cases were underestimated . The rate of high - risk undervaluation and the rate of underestimation of intraductal carcinoma were 16G : 48.0 % and 46.2 % , respectively .
18G : 53 . 3 % and 41.2 % . There was no statistical difference between the two kinds of puncture methods ( P0.01 ) . Among them , the high - risk lesion was underestimated and the rate of atypical hyperplasia was the highest , accounting for 52.5 % of all the high - risk understates .

( 2 ) Of the lesions that were diagnosed as papillary lesions before operation , 29 ( 32 . 2 % ) were underrated and 22 ( 24 . 4 % ) were moderately underestimated . Of the 23 lesions with atypical hyperplasia , 11 cases ( 5.8 % ) were underestimated . Of them , 10 were underestimated ( 40 % ) . In 18 G , 16 G empty core needle biopsy , the rate of histology was 17.9 % ( P = 0 . 017 ) and 16.0 % ( P = 0.023 ) , respectively , which were significantly higher than those of vacuum assisted puncture biopsy .

Conclusion

1 . Ultrasound guided 16G and 18G needle aspiration biopsy are accurate methods for the diagnosis of mass - type breast lesions with diameters greater than 10mm .

2 . ( 1 ) There is a high rate of underestimation of the high risk of intraductal carcinoma of the catheter by ultrasound - guided 16G and 18G needle aspiration biopsy , and further vacuum - assisted puncture biopsy or surgical resection of biopsy is required for the diagnosis .

( 2 ) The histological evaluation rate of breast papillary lesion was significantly lower than that of 16G and 18G hollow needle biopsy in the diagnosis of breast papillary lesions by vacuum assisted coarse needle aspiration biopsy .
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R445.1;R737.9

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