Keränen A K, Haapea M, Rissanen T
Radiology, Oulu University Hospital, OYS, Finland.
Ultraschall Med. 2016 Oct;37(5):497-502. doi: 10.1055/s-0035-1553256. Epub 2015 Jul 22.
To assess the visibility of breast micro-calcifications using ultrasonography (US) and the accuracy and clinical usefulness of vacuum-assisted biopsy (VAB) using US guidance (USVAB) as compared to stereotactic guidance (SVAB).
The study material comprised 158 retrospectively reviewed micro-calcification cases examined with US before VAB. The pre-biopsy US positivity frequency distributions were calculated, and the sensitivity, specificity and accuracy of VAB determined by comparing VAB histology with the surgical pathology or a 12-month follow-up.
158 US examinations yielded 80 positive and 78 negative results. US positivity correlated to a large size and a suspicious BI-RADS category of the calcifications. USVAB was performed in 49 cases with 61 % malignant, 12 % high-risk and 27 % benign results. The percentages for the 109 SVAB cases were 40 %, 28 % and 32 %, respectively. Specimen radiography demonstrated calcifications in 48 of the 49 (98 %) USVAB cases and in 107 of the 109 (98 %) SVAB cases. The overall accuracy of VAB was 94 % (USVAB 98 %, SVAB 94 %), the sensitivity was 88 % (USVAB 97 %, SVAB 83 %), and the specificity was 100 %. The higher sensitivity of USVAB was due to an accumulation of atypical hyperplasia diagnoses in the SVAB group. The final diagnosis was invasive ductal carcinoma in 21 US-positive and in 4 US-negative cases.
Approximately 50 % of mammographically detected micro-calcifications could be detected with ultrasonography. US was found to be a valuable alternative guidance method for vacuum-assisted biopsy of micro-calcifications with a technical success rate and diagnostic accuracy well comparable to the stereotactic method.
评估超声检查（US）对乳腺微钙化灶的可视性，以及与立体定向引导（SVAB）相比，超声引导下真空辅助活检（USVAB）的准确性和临床实用性。
研究材料包括158例回顾性分析的微钙化病例，这些病例在接受真空辅助活检前均接受过超声检查。计算活检前超声阳性频率分布，并通过将真空辅助活检组织学结果与手术病理或12个月随访结果进行比较，确定真空辅助活检的敏感性、特异性和准确性。
158次超声检查中，80次结果为阳性，78次为阴性。超声阳性与钙化灶的大尺寸和可疑的BI-RADS分类相关。49例患者接受了超声引导下真空辅助活检，其中恶性结果占61%，高危结果占12%，良性结果占27%。109例立体定向引导下真空辅助活检病例的相应比例分别为40%、28%和32%。标本射线照相显示，49例超声引导下真空辅助活检病例中有48例（98%）存在钙化，109例立体定向引导下真空辅助活检病例中有107例（98%）存在钙化。真空辅助活检的总体准确率为94%（超声引导下真空辅助活检为98%，立体定向引导下真空辅助活检为94%），敏感性为88%（超声引导下真空辅助活检为97%，立体定向引导下真空辅助活检为83%），特异性为100%。超声引导下真空辅助活检较高的敏感性是由于立体定向引导下真空辅助活检组中不典型增生诊断的积累。最终诊断为浸润性导管癌的病例中，超声阳性的有21例，超声阴性的有4例。
乳腺钼靶检查发现的微钙化灶中，约50%可通过超声检测到。超声被发现是微钙化灶真空辅助活检的一种有价值的替代引导方法，其技术成功率和诊断准确性与立体定向方法相当。
