超声引导下穿刺活检对乳腺病变诊断价值的研究进展

摘要
图/表
参考文献(32)
相关文章 (15)

全文: PDF (0 KB) HTML (41 KB)
输出: BibTeX | EndNote (RIS)

摘要

乳腺病变治疗决策的制定受病理结果影响，但穿刺病理低估的情况时有发生。为提高病变的检出率以及病理符合率，需评估那些容易被漏诊或低估的病变类型。本文通过分析近年来国内外超声引导下穿刺活检对不同乳腺病变类型的低估率、发生低估的可能原因及出现低估的高危因素得出结论：超声引导下穿刺活检对非肿块型及小体积乳腺病变的诊断可采用辅助手段提高检出率及评估准确性；对导管内乳头状病变及浸润性乳腺癌评估的准确性较高，但因肿瘤异质性及肿瘤中心坏死的存在需对浸润性乳腺癌多点取材，以提高免疫组化结论的符合率；对非典型增生、小叶原位癌、导管原位癌评估的准确性不理想，需要后续严密监测或采用手术治疗手段。对于可能恶性的乳腺病变，应在穿刺时使用穿刺鞘避免穿刺针道种植转移的发生，或在后续治疗中采取放射治疗手段降低种植转移概率。综上，超声引导空芯针穿刺活检是目前诊断乳腺病变的首选方法，核磁引导下穿刺活检和真空辅助下活检等可成为新的取材选择。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	张傲雪
	贾红燕

关键词 ：超声引导穿刺活检, 空芯针穿刺活检, 乳腺病变, 诊断价值

Abstract：

The decision-making for the treatment of breast lesions is affected by the pathological results,but the underestimation of puncture pathology occurs frequently.In order to improve the detection rate of lesions and the pathological coincidence rate,it is necessary to evaluate types of lesions which are easily missed or underestimated.This paper analyzed the underestimation rates of different types of breast lesions by ultrasound-guided needle biopsy in recent years,possible causes of underestimation,and high-risk factors for underestimation.Auxiliary methods could be used to improve the detection rate and evaluation accuracy of ultrasound-guided needle biopsy in the diagnosis of non-mass and small-volume breast lesions.The evaluation accuracies of intraductal papillary lesions and invasive breast cancer were relatively high.However,due to the tumor heterogeneity and tumor center necrosis,it was necessary to conduct multi-point selection of cancer materials for invasive breast cancer to improve the coincidence rate of immunohistochemical conclusions.The evaluation accuracies of atypical hyperplasia,lobular carcinoma in situ,and ductal carcinoma in situ were not ideal,and follow-up close monitoring or surgical treatment was required.For breast lesions that might be malignant,a puncture sheath should be used during puncture to avoid the occurrence of puncture needle implant transfer,or radiotherapy should be used in subsequent treatment to reduce the chance of implant transfer.In summary,ultrasound-guided hollow-core needle biopsy is currently the preferred method for diagnosing breast lesions.Nuclear magnetic-guided needle biopsy and vacuum-assisted biopsy can become new choices for material selection.

Key words： Ultrasound-guided needle biopsy Core needle biopsy Breast lesions Diagnostic value

通讯作者: 贾红燕，主任医师，博士生导师，研究方向：外科学乳腺疾病的诊疗

作者简介: 张傲雪（1993-），女，山西医科大学第一临床医学院外科学（乳腺方向）专业2018 级在读硕士研究生，研究方向：乳腺疾病的诊断和治疗

引用本文:

张傲雪；贾红燕. 超声引导下穿刺活检对乳腺病变诊断价值的研究进展[J]. 中国当代医药, 2021, 28(23): 36-39转44.
ZHANG Ao-xue； JIA Hong-yan. Research progress of the value of ultrasound-guided needle biopsy in diagnosis of breast lesions. 中国当代医药, 2021, 28(23): 36-39转44.

链接本文:

http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I23/36

[1]	Dinas K，Pratilas GC，Nasioutziki M，et al.Clinical significance of fine needle aspiration in managing patients with breast lesions[J].Folia Med（Plovdiv），2018，60（3）：364-372.
[2]	Lukasiewicz E，Ziemiecka A，Jakubowski W，et al.Fine -needle versus core-needle biopsy-which one to choose in preoperative assessment of focal lesions in the breasts?Literature review[J].J Ultrason，2017，17（71）：267-274.
[3]	Tamaki K，Sasano H，Ishida T，et al.Comparison of core needle biopsy（CNB）and surgical specimens for accurate preoperative evaluation of ER，PgR and HER2 status of breast cancer patients[J].Cancer Sci，2010，101（9）：2074-2079.
[4]	Xu P，Wu M，Yang M，et al.Evaluation of internal and shell stiffness in the differential diagnosis of breast non-mass lesions by shear wave elastography[J].World J Clin Cases，2020，8（12）：2510-2519.
[5]	Rizzo M，Linebarger J，Lowe MC，et al.Management of papillary breast lesions diagnosed on core-needle biopsy：clinical pathologic and radiologic analysis of 276 cases with surgical follow-up[J].J Am Coll Surg，2012，214（3）：280-287.
[6]	Park SY，Ko SS，Yoon CS，et al.Factors associated with disease upgrading in patients with papillary breast lesion in core-needle biopsy[J].Gland Surg，2020，9（4）：919-924.
[12]	张春，禹雪，张永辉，等.空芯针穿刺活检在乳腺导管内乳头状肿瘤中的诊断价值[J].中国微创外科杂志，2019，19（9）：800-802，816.
[16]	范照青，欧阳涛，李金锋，等.乳腺病变穿刺组织病理学检查非恶性结果的处理[J].中华医学杂志，2008，88（34）：2387-2390.
[21]	张国芬，张虹，辛灵，等.乳腺病灶空芯针穿刺活检与术后病理诊断一致性分析（附1394 例报告）[J].中国实用外科杂志，2014，34（7）：660-662.
[31]	曹威，何英剑，李金锋，等.超声引导下空芯针穿刺活检诊断的乳腺导管原位癌病理学低估的危险因素分析[J].中国癌症杂志，2020，30（3）：217-223.
[7]	Ko D，Kang E，Park SY，et al.The Management Strategy of Benign Solitary Intraductal Papilloma on Breast Core Biopsy[J].Clin Breast Cancer，2017，17（5）：367-372.
[8]	Han SH，Kim M，Chung YR，et al.Benign Intraductal Papilloma without Atypia on Core Needle Biopsy Has a Low Rate of Upgrading to Malignancy after Excision[J].J Breast Cancer，2018，21（1）：80-86.
[9]	Li X，Weaver O，Desouki MM，et al.Microcalcification is an important factor in the management of breast intraductal papillomas diagnosed on core biopsy[J]Am J Clin Pathol，2012，138（6）：789-795.
[10]	Pareja F，Corben AD，Brennan SB，et al.Breast intraductal papillomas without atypia in radiologic-pathologic concordant core-needle biopsies：Rate of upgrade to carcinoma at excision[J].Cancer，2016，122（18）：2819-2827.
[11]	Grimm LJ，Bookhout CE，Bentley RC，et al.Concordant，non-atypical breast papillomas do not require surgical excision：A 10-year multi-institution study and review of the literature[J].Clin Imaging，2018，51：180-185.
[13]	Sen LQ，Berg WA，Hooley RJ，et al.Core Breast Biopsies Showing Lobular Carcinoma In Situ Should Be Excised and Surveillance Is Reasonable for Atypical Lobular Hyperplasia[J].AJR Am J Roentgenol，2016，207（5）：1132-1145.
[14]	Wazir U，Wazir A，Wells C，et al.Pleomorphic lobular carcinoma in situ：Current evidence and a systemic review[J].Oncol Lett，2016，12（6）：4863-4868.
[15]	Mooney KL，Bassett LW，Apple SK.Upgrade rates of highrisk breast lesions diagnosed on core needle biopsy：a single-institution experience and literature review[J].Mod Pathol，2016，29（12）：1471-1484.
[17]	Chen LY，Hu J，Tsang JYS，et al.Diagnostic upgrade of atypical ductal hyperplasia of the breast based on evaluation of histopathological features and calcification on core needle biopsy[J].Histopathology，2019，75（3）：320-328.
[18]	Morrow M，Schnitt SJ，Norton L.Current management of lesions associated with an increased risk of breast cancer[J].Nat Rev Clin Oncol，2015，12（4）：227-238.
[19]	Sutton T，Farinola M，Johnson N，et al.Atypical ductal hyperplasia：Clinicopathologic factors are not predictive of upgrade after excisional biopsy[J].Am J Surg，2018，217（5）：848-850.
[20]	Mesurolle B，Perez JC，Azzumea F，et al.Atypical ductal hyperplasia diagnosed at sonographically guided core needle biopsy：frequency，final surgical outcome，and factors associated with underestimation[J].AJR Am J Roentgenol，2014，202（6）：1389-1394.
[32]	任重阳，廖宁，张国淳，等.乳腺真空辅助旋切系统活检后乳腺癌患者针道转移的几率[J].南方医科大学学报，2014，34（7）：1016-1019，1024.
[22]	Benyahia Z，Dussault N，Cayol M，et al.Stromal fibroblasts present in breast carcinomas promote tumor growth and angiogenesis through adrenomedullin secretion[J].Oncotarget，2017，8（9）：15 744-15 762.
[23]	Moelans CB，de Groot JS，Pan X，et al.Clonal intratumor heterogeneity of promoter hypermethylation in breast cancer by MS-MLPA[J].Mod Pathol，2014，27（6）：869-874.
[24]	Zhu S，Wu J，Huang O，et al.Clinicopathological Features andDiseaseOutcomeinBreastCancerPatientswithHormonal Receptor Discordance between Core Needle Biopsy and Following Surgical Sample[J].Ann Surg Oncol，2019，26（9）：2779-2786.
[25]	Kombak FE，Sahin H，Mollamemisoglu H，et al.Concordance of immunohistochemistry between core needle biopsy and surgical resection of breast cancer[J].Turk J Med Sci，2017，47（6）：1791-1796.
[26]	You K，Park S，Ryu JM，et al.Comparison of Core Needle Biopsy and Surgical Specimens in Determining Intrinsic Biological Subtypes of Breast Cancer with Immunohistochemistry[J].J Breast Cancer，2017，20（3）：297-303.
[27]	Asogan AB，Hong GS，Arni Prabhakaran SK.Concordance between core needle biopsy and surgical specimen for oestrogen receptor，progesterone receptor and human epidermal growth factor receptor 2 status in breast cancer[J].Singapore Med J，2017，58（3）：145-149.
[28]	Jung I，Kim MJ，Moon HJ，et al.Ultrasonography-guided 14-gauge core biopsy of the breast：results of 7 years of experience[J].Ultrasonography，2018，37（1）：55-62.
[29]	Caswell-Smith P，Wall M.Ductal carcinoma in situ：Is core needle biopsy ever enough?[J].J Med Imag Radiat Oncol，2016，61（1）：29-33.
[30]	Kim J，Han W，Lee JW，et al.Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision[J].Breast，2012，21（5）：641-645.
[33]	Santiago L，Adrada BE，Huang ML，et al.Breast cancer neoplastic seeding in the setting of image-guided needle biopsies of the breast[J].Breast Cancer Res Treat，2017，166（1）：29-39.