Hasselgren P O, Hummel R P, Georgian-Smith D, Fieler M
Department of Surgery, University of Cincinnati Medical Center, Ohio.
Surgery. 1993 Oct;114(4):836-40; discussion 840-2.
One of the more frustrating complications after breast biopsy with needle localization is a missed lesion. To reduce the number of missed lesions, radiographs of the surgical specimen are usually obtained. In this study we determined the accuracy of specimen x-ray, the incidence of missed lesions, and the management of patients with this complication.
The result of specimen x-ray was compared with that of a postoperative mammogram in 192 patients who underwent breast biopsy with needle localization. The incidence of missed lesions was also determined from postoperative mammogram, and the management of patients with this complication was analyzed.
The incidence of false-positive specimen x-ray was 7.8% and that of false-negative 55%. The sensitivity, specificity, and accuracy of specimen x-ray were 96%, 28%, and 89%, respectively. The incidence of missed lesions was 3.2% and of incompletely excised lesions 6.4%. Eighteen of 24 patients with a missed or incompletely excised lesion were treated expectantly because postoperative mammogram showed the lesion to be stable. None of these patients has required a subsequent biopsy.
Specimen x-ray can be false positive or false negative. An important implication of this finding is that a postoperative mammography should always be performed after biopsy with needle localization, regardless of the result of the specimen x-ray, to make certain the lesion has not been missed.
针定位乳腺活检术后较令人沮丧的并发症之一是病变漏诊。为减少漏诊病变的数量，通常会对手术标本进行X线摄影。在本研究中，我们确定了标本X线摄影的准确性、漏诊病变的发生率以及该并发症患者的处理方法。
将192例行针定位乳腺活检患者的标本X线摄影结果与术后乳腺钼靶检查结果进行比较。通过术后乳腺钼靶检查确定漏诊病变的发生率，并分析该并发症患者的处理方法。
标本X线摄影假阳性率为7.8%，假阴性率为55%。标本X线摄影的敏感性、特异性和准确性分别为96%、28%和89%。漏诊病变的发生率为3.2%，切除不完全病变的发生率为6.4%。24例有漏诊或切除不完全病变的患者中，18例因术后乳腺钼靶检查显示病变稳定而采取观察等待。这些患者均未进行后续活检。
标本X线摄影可能出现假阳性或假阴性。这一发现的一个重要意义在于，无论标本X线摄影结果如何，针定位活检术后都应常规进行术后乳腺钼靶检查，以确保未漏诊病变。
