Ames Victoria, Britton Peter D
Department of Radiology, Cambridge Breast Unit, Addenbrooke's Hospital, Box 97, Cambridge, UK CB2 2QQ.
Insights Imaging. 2011 Apr;2(2):171-176. doi: 10.1007/s13244-010-0064-1. Epub 2011 Jan 20.
The aims of this review are to compare and contrast the available stereotactic equipment, and to describe the variety of needle types used and their affect on pathological results and subsequent patient management. Initial stereotactic devices were "added-on" to analogue mammography units and have been replaced by prone or ducubitus equipment using digital image acquisition. Biopsies use either 14-G core biopsy (CB) needles or vacuum-assisted biopsies (VAB). Vacuum-assisted biopsy systems consistently out-perform 14-G CB with reduced need for diagnostic or multi-treatment surgery. The false-negative rate is 8% for 14-G CB compared with 0.7% for VAB. There is a risk of underestimating the disease present for lesions of uncertain malignant potential (Cat B3) and suspicious of malignancy (Cat B4) results with 25% of patients with a B3 biopsy found to have cancer at subsequent surgery and 66% of those with a B4 biopsy. A CB diagnosis of in situ malignancy is upgraded to invasive disease at surgery in 15-36% of patients undergoing CB and of the order of 10% with VAB. A high degree of diagnostic accuracy and hence safe patient care can only be achieved by meticulous attention to technique and multi-disciplinary cooperation.
本综述的目的是比较和对比现有的立体定向设备，描述所使用的各种针类型及其对病理结果和后续患者管理的影响。最初的立体定向设备是“附加”在模拟乳腺摄影设备上的，现已被采用数字图像采集的俯卧位或卧位设备所取代。活检使用14G粗针活检（CB）针或真空辅助活检（VAB）。真空辅助活检系统始终优于14G CB，减少了诊断性或多次治疗性手术的需求。14G CB的假阴性率为8%，而VAB为0.7%。对于恶性潜能不确定（B3类）和怀疑恶性（B4类）的病变，存在低估疾病存在情况的风险，25%的B3活检患者在后续手术中被发现患有癌症，B4活检患者中这一比例为66%。在接受CB的患者中，15% - 36%的原位恶性肿瘤CB诊断在手术时升级为浸润性疾病，VAB的这一比例约为10%。只有通过对技术的精心关注和多学科合作，才能实现高度的诊断准确性，从而实现安全的患者护理。
