- 期刊
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Automated Stereotaxic Core Needle Biopsy of Breast Lesions
乳房病變之立體定位自動性粗針組織切片
摘要
偽評估三度空間立體定位自動性粗針組織切片(SCNB)在乳房病變之應用及有效性，對26個在乳房攝影疑有乳房病變並施以SCNB之病例作了回逆性之研究。所有病變皆經超音波掃描證實為非囊性。懷疑病變在乳房攝影之徵象包括顯微鈣化（15例）、結節合併鈣化（7例）、放射狀結節伴隨顯微鈣化（2例）、腫塊（1例）及乳房組織變形（1例）。根據美國放射線學學院所建議的Breast Imaging Reporting and Data System(BI-RADS)，乳房攝影異常徵象，2例屬於分類(category)三，15例屬於分類四，9例屬於分類五。患者是在臥姿之情況下，以前端可發射22mm長之自動組織切片槍實行SCNB。26個病患中，25個用到16G之切片針，1個用到14G之切片針。每一病變取樣次數為4到10次，平均5次。取樣後並以放大攝影評估樣本是否伴有鈣化。 經SCNB取得樣本之病理檢查結果12例為良性病變（5例纖維腺瘤、4例纖維囊腫病變、2例纖維化伴隨鈣化、1例腺瘤化），7例為正常乳房組織及7例為乳癌。所有屬於分類三和分類四之病變，經SCNB及病理檢查証實為良性，9例屬於分類五之病變，7例(78%)經SCNB及病理檢查証實為乳癌，另2例為良性。24例在乳房攝影有呈現鈣化之病變，14(58%)例在樣本之放大攝影中有呈現鈣化。SCNB後沒有血腫或感染等併發症之發生，僅1例因結節性鈣化在作SCNB時針頭彎曲，只好以外科手術將結節和切片針一併取出。 總之，為診斷乳房病變，SCNB是有效及安全的組織切片方法。對有些患者，SCNB可排除非必要的外科手術。應避免直接從極度鈣化之結節作SCNB以摘取組織。
並列摘要
To assess the feasibility of automated stereotaxic core needle biopsy (SCNB) on breast lesions, 26 cases of mammographically suspected breast lesions that underwent SCNB were retrospectively studied. SCNB was restricted to patients with suspect breast lesions presented as microcalcification (15 cases), nodular density with calcification (7 cases), spiculated mass with microcalcification (2 cases), nodule (1 case) or architectural distortion (1 case) on mammograms. None of the suspected lesions were cystic on sonograms. According to the Breast Imaging Reporting and Data System (BI-RADS) developed by American College of Radiology, the lesions on mammograms were classified as probably benign lesions (BI-RADS category 3) in 2 cases, low-to-intermediate lesions (BI-RADS category 4) in 15, and highly suspect for malignancy (BIRADS category 5)in 9. SCNB was performed on all patients. The number of specimens obtained from each lesion ranged from 4 to 10 (mean 5). Magnification radiography was used to evaluate calcification in specimen. The pathological examination of specimens from SCNB revealed benign lesions in 12 patients (fibroadenoma in 5, fibrocystic change 4, fibrosis with calcification 2, and adenosis in one), normal breast tissue in 7, and breast carcinoma in 7. All the lesions classified as BI-RADS category 3 or 4 were proved to be benign by SCNB, while 78% (7 of 9) of lesions shown as BI-RADS category 5 on mammograms were proved to be malignant by SCNB. Of 24 cases with calcification on mammograms, 14 (58%) revealed calcification on specimen radiographs. One patient with calcified fibroadenoma had a complication of bending of biopsy needle during the SCNB procedure causing failure of needle withdrawal. In conclusion, SCNB is an efficient and safe alternative in obtaining sufficient tissues for diagnosing breast lesions. It may spare some selected patients a surgical biopsy procedure. One should avoid directly targeting a densely calcified nodule.