Tozaki Mitsuhiro, Yamashiro Norie, Suzuki Takako, Kawano Naoko, Ozaki Shinji, Sakamoto Naomi, Abe Satoko, Ogawa Tomoko, Katayama Nobuhito, Tsunoda Yuko, Fukuma Eisuke
Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan.
Breast Cancer. 2009;16(2):121-5. doi: 10.1007/s12282-008-0074-8. Epub 2008 Sep 20.
In the United States and Europe, MR-guided vacuum-assisted biopsy (VAB) is required for MR-only visible suspicious lesions that cannot be identified with mammography or ultrasonography. However, it is controversial as to whether MR-guided VAB is essential or not in Japan. The purpose of this study was to clarify the frequency of malignancy among the patients that underwent MR-guided VAB, and to discuss the need for this technique in Japan.
This study was approved by the Institutional Review Board of our hospital. A retrospective review was performed of 30 consecutive patients who had undergone MR-guided 11-gauge VAB. The biopsies were performed on a 1.5 T MR scanner using a commercially available biopsy system. All lesions seen with MRI could not be detected by mammography and second-look ultrasonography.
All 30 lesions were assessed as category 4 or 5. The average lesion size of a mass enhancement before biopsy was 0.7 cm, and the average lesion size of a non-mass-like enhancement was 2.3 cm. The average number of cores of VAB was 19. The median time required to perform the VAB procedure was 35 min. The biopsy was successfully performed without important side effects in all patients. Histopathological findings were invasive ductal carcinoma in one (3%); ductal carcinoma in situ (DCIS) in seven (23%); and benign in 22 (73%). In one case, atypical ductal hyperplasia at VAB was upgraded to DCIS at surgical excision.
MR-guided VAB can be performed safely and it is needed for MR-only visible suspicious lesions in Japan.
在美国和欧洲，对于仅在磁共振成像（MR）上可见而乳腺X线摄影或超声检查无法识别的可疑病变，需要进行MR引导下真空辅助活检（VAB）。然而，在日本，MR引导下VAB是否必要存在争议。本研究的目的是明确接受MR引导下VAB患者的恶性肿瘤发生率，并讨论该技术在日本的必要性。
本研究经我院机构审查委员会批准。对连续30例行MR引导下11号VAB的患者进行回顾性分析。活检在1.5T MR扫描仪上使用市售活检系统进行。所有MRI可见的病变在乳腺X线摄影和二次超声检查中均未被检测到。
所有30个病变均被评估为4类或5类。活检前肿块强化的平均病变大小为0.7cm，非肿块样强化的平均病变大小为2.3cm。VAB的平均取材条数为19条。进行VAB操作的中位时间为35分钟。所有患者均成功完成活检，无重要副作用。组织病理学结果为浸润性导管癌1例（3%）；导管原位癌（DCIS）7例（23%）；良性22例（73%）。1例患者VAB时的非典型导管增生在手术切除时升级为DCIS。
MR引导下VAB可以安全进行，在日本，对于仅在MR上可见的可疑病变是必要的。
