乳腺肿块徒手和超声引导芯针穿刺活检比较研究.docVIP

乳腺肿块徒手和超声引导芯针穿刺活检比较研究 　　【摘要】 目的 探讨超声引导对提高乳腺肿块芯针穿刺活检准确性的价值。方法 256例乳腺肿块患者280个病灶，术前采用自身对照的方法进行徒手和超声引导下的芯针穿刺活检（NCB）。对患者的NCB资料与术后病检结果进行比较分析。结果 术后病理诊断恶性病变142个，良性病变138个。徒手和超声引导NCB的敏感性分别为90.1%（128/142）和98.6%（140/142），假阴性率分别为9.9%（14/142）和1.6%（2/142）,低估率分别为9.2%（13/142）和3.5%（5/142），特异性均为100%（138/138），恶性病变诊断符合率分别为85.2%（121/142）和96.5%（137/142）。二者的敏感性和恶性病变诊断符合率均具有显著差异（分别χ2/sup10.20，P2/sup10.84，P 　　【关键词】 乳腺肿瘤； 芯针穿刺活检； 超声引导 　　Comparative study of freehand and US-guided needle core biopsy in diagnosing breast tumors WANG Zhi-hua.Puyang Maternal and Child Health Hospital in Henan Province,Puyang 457000,China 　　【Abstract】 Objective In order to improve the accuracy of needle core biopsy（NCB）,this article compare the value of freehand and US-guided NCB in diagnosing breast tumors.Methods Freehand and US-guided NCB were perfored on 256 patients with 280 breast tumors by the own comparative method before operation.The freehand and US-guided NCB and histopathological diagnosis results were compared and analyzed.Results 142 m alignant lesiones and 138 benign lesiones were diagnosed by pathology after operation in 256 patients with 280 breast tumors.Of the freehand and US-guided NCB,The sensitivity was 90.1%（128/142）and 98.6%（140/142）,the false negative rate was 9.9%（14/142）and 1.6%（2/142）,the underestimate rate was 9.2%（13/142）and 3.5% （5/142）,the specificity was 100% （138/138） and 100% （138/138）,the coincidence rate of m alignant lesiones was 85.2%（121/142）and 96.5%（137/142）,respectively.The sensitivity and the coincidence rate m alignant lesiones of US-guided NCB were remarkably higher than that of freehand NCB respectively（χ2/sup10.20，P2/sup10.84，P2.1 cm 58个；超声BI-RADS分级，4级172例，5级108例。 　　1.2 方法 穿刺设备为美国巴德公司生产的巴德穿刺枪，活检针为14 G。经患者知情同意，在徒手穿刺获取标本后再进行超声引导下的穿刺取样，标本???号后送常规病检。（1）徒手穿刺：常规皮肤消毒，0.5%的利多卡因浸润麻醉，于肿块一侧尖刀片刺破皮肤2 mm,左手固定肿物，右手持穿刺抢平行胸壁至45°角度经切口推进至肿物，感觉肿物有被针尖推动感时击发穿刺针，抽出穿刺针，取出标本，一般取标本2～3条，操作中注意切勿损伤胸壁。（2）超声引导下穿刺：高频超声探头涂抹耦合剂后用无菌塑料套包裹，络合碘作耦合剂扫查乳腺，观察到病灶后固定，穿刺针与探头平行于探头一端斜行进针，使声束可明确观察到针体和针尖的强回声反射