Hann L E, Liberman L, Dershaw D D, Cohen M A, Abramson A F
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
AJR Am J Roentgenol. 1995 Jul;165(1):59-62. doi: 10.2214/ajr.165.1.7785633.
The purpose of this study was to determine whether mammography immediately after stereotaxic core breast biopsy should be performed routinely to diagnose hematoma, to confirm the sampling site, and to establish a new baseline for future mammograms.
Stereotaxic core biopsies of 113 mammographically indeterminate or suspicious lesions were performed by use of a dedicated stereotaxic table with digital imaging, a 14-gauge needle, and an automated gun. The indication for biopsy was a mass with or without calcifications in 59 cases (52%) and calcifications without a mass in 54 cases (48%). The number of core biopsies per case ranged from one to 16 (mean = six). Craniocaudal and mediolateral oblique mammograms of the sampled breast were obtained immediately after the biopsies and were compared with prebiopsy mammograms. In cases with microcalcifications, the mammograms also were compared with specimen radiographs.
Mammograms obtained immediately after the procedure showed changes related to the biopsy in 86 cases (76%). These findings included decreased lesion size in 11 (10%), air at the biopsy site in 47 (42%), and hematoma, manifested as poorly defined increased density at the biopsy site, in 58 (51%). One hematoma was clinically significant, but the remaining 57 were clinically occult. When core biopsies were performed for calcifications, the postprocedural mammograms showed a decrease in the number of calcifications in 26 (48%) of 54 cases, but specimen radiographs showed calcium in 50 (93%) of 54 cases. Four lesions (three masses and one cluster of microcalcifications) disappeared after biopsy. In three cases, hematomas obscured residual calcifications at the biopsy site.
Mammography immediately after core biopsy is not necessary for the diagnosis of procedure-related hematoma and is inferior to specimen radiography for verifying that calcifications have been sampled. Postprocedural mammograms also may be suboptimal for the establishment of a new baseline because of the frequent finding of hematoma.
本研究的目的是确定在立体定向乳腺粗针活检后是否应常规进行乳房X线摄影，以诊断血肿、确认取材部位，并为未来的乳房X线照片建立新的基线。
使用配有数字成像的专用立体定向检查台、14号针和自动活检枪，对113例乳房X线摄影显示不确定或可疑的病变进行立体定向粗针活检。活检指征为59例（52%）有或无钙化的肿块以及54例（48%）无肿块的钙化。每例的粗针活检次数为1至16次（平均6次）。活检后立即获取取材乳房的头尾位和内外斜位乳房X线照片，并与活检前的乳房X线照片进行比较。对于有微钙化的病例，乳房X线照片还与标本X线片进行比较。
术后立即获得的乳房X线照片显示86例（76%）有与活检相关的改变。这些表现包括11例（10%）病变大小减小、47例（42%）活检部位有气体以及58例（51%）血肿，表现为活检部位密度增加且边界不清。1例血肿具有临床意义，其余57例为临床隐匿性。当针对钙化进行粗针活检时，术后乳房X线照片显示54例中有26例（48%）钙化数量减少，但标本X线片显示54例中有50例（93%）存在钙质。4个病变（3个肿块和1组微钙化）在活检后消失。3例中，血肿掩盖了活检部位残留的钙化。
粗针活检后立即进行乳房X线摄影对于诊断与操作相关的血肿并非必要，并且在验证钙化是否已被取材方面不如标本X线片。由于经常发现血肿，术后乳房X线照片在建立新基线方面也可能不理想。
