Schmidt R A
University of Chicago, Illinois, USA.
CA Cancer J Clin. 1994 May-Jun;44(3):172-91. doi: 10.3322/canjclin.44.3.172.
The substantial majority of questionable lesions detected by mammography are benign, and there is growing interest among health care professionals and patients in alternatives to surgical biopsy for diagnosing these lesions. Stereotactic breast biopsy is an x-ray guided method for localizing and sampling breast lesions discovered on mammography and considered to be suspicious for malignancy. Its use in sampling small, nonpalpable breast lesions has been investigated over the past 15 years, using fine-needle aspiration for cytology and, more recently, core-needle biopsy for histology. Multiple series comparing stereotactic biopsy with surgical biopsy have shown that stereotactic techniques accurately sample small lesions and have a sensitivity of 90 to 95 percent for breast cancer detection. State-of-the-art stereotactic breast biopsy is comparable in sensitivity to surgical biopsy, and the procedure is quicker, cheaper, and easier than the standard practice of preoperative, mammographically guided localization followed by surgical biopsy. In an age of miniaturization, stereotactic techniques provide miniature breast biopsies. The University of Chicago acquired the first prone stereotactic table in the United States in 1986, and we have found stereotactic breast biopsy to be a very good alternative for certain lesions that would otherwise require surgical biopsy for diagnosis. Most lesions (70 percent) sent to conventional biopsy at the University of Chicago between 1986 and 1989 were graded by observers as being in a low-suspicion category (less than 10 percent chance of malignancy based on mammographic findings), and the positive malignancy yield of this category of lesions was seven percent. These lesions were also examined with stereotactic fine-needle aspiration performed as a "piggy-back" procedure to the needle localization for surgery. The results of this study have led us to use stereotactic biopsy rather than surgical biopsy for low-suspicion lesions since then. We currently use stereotactic breast biopsy for about half the nonpalpable lesions considered for breast biopsy at our institution and find it to be reliable and readily accepted by informed patients. The introduction of automated core-biopsy guns has escalated interest in the technique, due to increased confidence in the histologic samples obtained and the ability to make specific benign diagnoses more frequently. Some centers have extended the potential use of stereotaxis to virtually all suspicious mammographic lesions, including those with a high probability of malignancy, to plan definitive surgery. Based on current estimates, there are now over 1,000 centers either investigating or using stereotactic biopsy for occult breast lesions.
乳房X线摄影检测出的绝大多数可疑病变都是良性的，医疗保健专业人员和患者对用于诊断这些病变的手术活检替代方法的兴趣与日俱增。立体定向乳腺活检是一种在乳房X线摄影中发现并被认为有恶性可疑的乳腺病变进行定位和取样的X线引导方法。在过去15年里，人们研究了其在对不可触及的小乳腺病变取样方面的应用，采用细针穿刺进行细胞学检查，最近则采用粗针活检进行组织学检查。多个将立体定向活检与手术活检进行比较的系列研究表明，立体定向技术能准确地对小病变进行取样，对乳腺癌检测的敏感度为90%至95%。最先进的立体定向乳腺活检在敏感度上与手术活检相当，而且该程序比术前乳房X线摄影引导下定位然后进行手术活检的标准做法更快、更便宜且更容易。在小型化时代，立体定向技术提供了微型乳腺活检。芝加哥大学于1986年在美国购置了第一台俯卧位立体定向台，我们发现立体定向乳腺活检对于某些否则需要手术活检来诊断的病变而言是一种非常好的替代方法。1986年至1989年间在芝加哥大学送去进行传统活检的大多数病变（70%），观察者将其归类为低可疑类别（根据乳房X线摄影结果恶性可能性小于10%），这类病变的恶性阳性检出率为7%。这些病变还通过作为手术针定位的“附加”程序进行的立体定向细针穿刺进行了检查。这项研究的结果使我们从那时起就对低可疑病变采用立体定向活检而非手术活检。目前，我们机构对约一半考虑进行乳腺活检的不可触及病变采用立体定向乳腺活检，发现它可靠且易于被了解情况的患者接受。自动粗针活检枪的引入提升了人们对该技术的兴趣，这是因为对所获得的组织学样本更有信心，而且能够更频繁地做出明确的良性诊断。一些中心已将立体定向技术的潜在应用扩展到几乎所有可疑的乳房X线摄影病变，包括那些恶性可能性很高的病变，以规划确定性手术。根据目前的估计，现在有超过1000个中心正在研究或使用立体定向活检来诊断隐匿性乳腺病变。
