Zheng Jianwei, Cai Shuyan, Song Huimin, Wang Yunlei, Han Xiaofeng, Han Gang, Wu Haoliang, Gao Zhigang
Department of General Surgery, Beijing Chaoyang Hospital Affiliated with Capital Medical University, Beijing, China.
Gland Surg. 2020 Oct;9(5):1346-1353. doi: 10.21037/gs-20-344.
The exact factors and mechanisms involved in the development of hematoma after breast ultrasound (US)-guided vacuum-assisted biopsy (VAB) are not clear. This study aimed to analyze the occurrence, prognosis, and risk factors of hematoma after US-guided VAB for the removal of benign breast lesions.
This was a retrospective study of consecutive female patients with breast lesions (BI-RADS 3/4a/4b and confirmed as benign by core needle biopsy) removed by percutaneous excisional biopsy by US-guided VAB at the Beijing Chaoyang Hospital from April 2016 to December 2018. Univariable analyses were conducted to identify the factors associated with hematoma (age, nodule size, laterality, nodule location, number of nodules, BI-RADS classification of ultrasound, pathology, breast shape, menstrual period, efficacy time of bandage, and hemostatic agents). Multivariable analysis was performed to identify the factors independently associated with hematoma.
A total of 293 patients (343 breast lesions) were included. Lesion removal was successful in all cases. Hematomas ≥1 cm were found in 39 patients. Finally, 38 (97.4%) hematomas were absorbed completely within 6 months. The multivariable logistic regression analysis revealed that lesion size (P<0.001; OR: 5.775; 95% CI: 2.752-12.121), number of lesions (P=0.011; OR: 3.205, 95% CI: 1.311-7.834), and the efficacy time of bandage 12-24 h (P=0.003; OR: 5.257, 95% CI: 1.792-15.421) were independently associated with hematoma occurrence after US-guided VAB excision of breast lesions. A lesion size cut-off of 23.4 mm (AUC 0.764, 95% CI: 0.692-0.837; 59.0% sensitivity; 80.3% specificity; 77.5% accuracy; P<0.001) could predict hematoma occurrence.
US-guided excisional VAB can effectively remove benign breast lesions. The factors independently associated with postoperative hematoma are lesion size, lesion number, and effective postoperative compression time of bandage.
乳腺超声（US）引导下真空辅助活检（VAB）后血肿形成的确切因素和机制尚不清楚。本研究旨在分析US引导下VAB切除良性乳腺病变后血肿的发生情况、预后及危险因素。
这是一项回顾性研究，纳入了2016年4月至2018年12月在北京朝阳医院接受US引导下VAB经皮切除活检的连续女性乳腺病变患者（乳腺影像报告和数据系统[BI-RADS] 3/4a/4b类，粗针活检确诊为良性）。进行单因素分析以确定与血肿相关的因素（年龄、结节大小、侧别、结节位置、结节数量、超声BI-RADS分类、病理、乳房形态、月经期、绷带包扎有效时间及止血剂）。进行多因素分析以确定与血肿独立相关的因素。
共纳入293例患者（343个乳腺病变）。所有病例病变切除均成功。39例患者发现血肿≥1 cm。最终，38例（97.4%）血肿在6个月内完全吸收。多因素logistic回归分析显示，病变大小（P<0.001；OR：5.775；95%CI：2.752-12.121）、病变数量（P=0.011；OR：3.205，95%CI：1.311-7.834）及绷带包扎有效时间12-24小时（P=0.003；OR：5.257，95%CI：1.792-15.421）与US引导下乳腺病变VAB切除术后血肿发生独立相关。病变大小截断值为23.4 mm（AUC 0.764，95%CI：0.692-0.837；灵敏度59.0%；特异度80.3%；准确度77.5%；P<0.001）可预测血肿发生。
US引导下切除性VAB能有效切除良性乳腺病变。与术后血肿独立相关的因素为病变大小、病变数量及术后绷带有效压迫时间。
