Wolf G, Helbich T
Universitätsklinik für Radiodiagnostik, Wien.
Wien Med Wochenschr. 1998;148(14):316-20.
Interventional procedures, whether markings or core biopsies, are very important for clarifying non-palpable breast lesions. Both at present as well as in future--in the age of breast screening--such methods must be used more and more. Although breast screening is not carried out on an organized basis in our country, it is gaining importance. Currently there is a covert screening in progress and women are availing this facility to an increasing extent. Various organisations including the press and audio-visual media have arisen the interest of the population. An increase in diagnostic studies is being flanked by an increase in surgical activity. As a result, on the one hand a larger number of small carcinomas as well as benign lesions are being operated. This has brought the cost-bearers, i.e. all of us, to the limits of what can be done. Surgery costs money. One solution to the problem is preoperative marking which is used in all patients suspected of carcinoma, and the other is core biopsy which is used in lesions that appear benign on X-rays. Radiologically benign lesions are not histological diagnoses. Although a well trained radiologist will make the correct diagnosis in 95 to 98% of cases, the possibility of error is still 2 to 50%. In the light of this knowledge, it would appear logical to operate all apparently benign lesions. However, a more intensive use of bioptic procedures is a solution to this problem. To compare costs: Surgery for clarification of a lesion involves a hospital stay of about 3 days while bioptic studies can be carried out on an outpatient basis. Besides, surgery costs 2 to 3 times more than bioptic studies, depending on the hospital and the bioptic material used. A core biopsy needle costs about two-thirds the price of a rotating cannula. However, it should be emphasized that core biopsy is not a method of treatment and will never be one. It should remain a diagnostic procedure, although small lesions may well be aspirated by this method. The ABBI systems is intended to be a therapeutic method. At present, no final statement can be made about the utility of this procedure.
介入性操作,无论是标记还是核心活检,对于明确不可触及的乳腺病变都非常重要。在当前以及未来——在乳腺筛查时代——此类方法的使用必将越来越多。尽管我国尚未有组织地开展乳腺筛查,但它正变得越来越重要。目前正在进行一种隐性筛查,女性利用这一设施的程度也在不断提高。包括新闻媒体和视听媒体在内的各种组织都引发了公众的兴趣。诊断性研究的增加伴随着手术活动的增加。结果,一方面,更多的小癌以及良性病变得以手术切除。这使得费用承担者,也就是我们所有人,面临所能承受的极限。手术是要花钱的。解决这个问题的一个办法是对所有疑似癌症的患者进行术前标记,另一个办法是对X线表现为良性的病变进行核心活检。放射学上的良性病变并非组织学诊断。尽管训练有素的放射科医生在95%至98%的病例中能做出正确诊断,但出错的可能性仍有2%至5%。鉴于此,对所有明显良性的病变进行手术似乎合乎逻辑。然而,更广泛地使用活检程序是解决这一问题的办法。比较一下费用:为明确病变进行的手术需要住院约3天,而活检研究可以在门诊进行。此外,手术费用比活检研究高出2至3倍,这取决于医院和所使用的活检材料。一根核心活检针的价格约为旋转套管针的三分之二。然而,应该强调的是,核心活检不是一种治疗方法,也永远不会成为一种治疗方法。它应该仍然是一种诊断程序,尽管小病变很可能通过这种方法被吸出。ABBI系统旨在成为一种治疗方法。目前,关于这一程序的效用尚无最终定论。