Schulz-Wendtland R, Heywang-Köbrunner S H, Aichinger U, Krämer S, Wenkel E, Bautz W
Institut für Diagnostische Radiologie, Universität Erlangen-Nürnberg, Germany.
Rofo. 2002 May;174(5):620-4. doi: 10.1055/s-2002-28278.
We wanted to determine if tissue marker clips after sonographically or stereotactically guided breast biopsy improve the follow-up of small breast lesions classified BI-RADS 4/5 and the localisation of breast cancer (TNM stage 2 or 3) after neoadjuvant chemotherapy.
Prospective analysis was performed of 108 breast lesions 1 cm or smaller mammographically classified as BI-RADS 4/5 and 14 breast lesions larger than 2 cm mammographically classified as BI-RADS 5. 33 of the 108 breast lesions 1 cm or smaller underwent sonographic core cut breast biopsy (group 1) and 75 stereotactic vacuum-assisted breast biopsy (group 2). All 14 lesions greater than 2 cm were stereotactically vacuum-assisted breast biopsied (group 3). The centre of the lesion was marked by a clip after the biopsy. Mammographies were performed in all patients of group 1 and 2 with a histologically benign finding (n = 31, n = 69, respectively) and in all patients of group 3 directly after clip placement and after 6 and 12 months. Clip localisation and possible divergence from the original position were verified by a grid.
Two patients of group 1 and 6 patients of group 2 had breast conservative surgery (BET) because of the histological diagnosis of a ductal carcinoma in situ or invasive breast cancer. The tissue marker clips of the remaining 31 patients of group 1 and 69 patients of group 2 diverged with a mean value of 0.4 cm (standard deviation +/- 0.23 cm; range 0.1 cm to 0.9 cm) from their placement position after 6 months. After 12 months the marker clips deviated with a mean value of 0.4 cm (standard deviation +/- 0.21 cm; range 0.1 cm to 0.9 cm) in 94 patients and 0.8 cm (standard deviation +/- 0.25 cm; range 0.1 cm to 0.9 cm) in 6 patients from their original location. No tumour progression of the benign lesions in group 1 and 2 was diagnosed in follow-up mammograms. In all patients of group 3 the tissue marker clips were the only possibility to localize the tumour after neoadjuvant chemotherapy as all other diagnostic methods showed inconsistent results.
Positioning a tissue marker clip in the tumour centre seems to be reasonable after interventional biopsy of breast lesions of 1.0 cm or smaller and before neoadjuvant chemotherapy.
我们想要确定在超声或立体定向引导下的乳腺活检后放置组织标记夹，是否能改善对超声影像分类为BI-RADS 4/5的小乳腺病变的随访，以及新辅助化疗后乳腺癌（TNM分期为2或3期）的定位。
对108例乳腺钼靶检查显示直径1厘米或更小、分类为BI-RADS 4/5的乳腺病变以及14例乳腺钼靶检查显示直径大于2厘米、分类为BI-RADS 5的乳腺病变进行前瞻性分析。108例直径1厘米或更小的乳腺病变中有33例接受了超声引导下的乳腺粗针穿刺活检（第1组），75例接受了立体定向真空辅助乳腺活检（第2组）。所有14例直径大于2厘米的病变均接受了立体定向真空辅助乳腺活检（第3组）。活检后用夹子标记病变中心。第1组和第2组组织学检查结果为良性的所有患者（分别为31例和69例）以及第3组所有患者在夹子放置后、6个月和12个月时均进行了乳腺钼靶检查。通过网格验证夹子的定位以及与原始位置可能的偏差。
第1组有2例患者和第2组有6例患者因组织学诊断为原位导管癌或浸润性乳腺癌而接受了保乳手术（BET）。第1组其余31例患者和第2组69例患者的组织标记夹在6个月后与其放置位置的平均偏差为0.4厘米（标准差±0.23厘米；范围0.1厘米至0.9厘米）。12个月后，94例患者的标记夹偏离其原始位置的平均值为0.4厘米（标准差±0.21厘米；范围0.1厘米至0.9厘米），6例患者的偏差为0.8厘米（标准差±0.25厘米；范围0.1厘米至0.9厘米）。在随访乳腺钼靶检查中未诊断出第1组和第2组良性病变的肿瘤进展。在第3组所有患者中，新辅助化疗后组织标记夹是定位肿瘤的唯一方法，因为所有其他诊断方法的结果都不一致。
对于直径1.0厘米或更小的乳腺病变，在介入活检后且在新辅助化疗前，在肿瘤中心放置组织标记夹似乎是合理的。
