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目的探讨自动乳腺全容积成像冠状面引导下的乳腺组织学穿刺活检在乳腺非肿块性病变诊断中的应用价值。方法回顾性分析123例经乳腺自动全容积成像检查发现的乳腺非肿块性病变,冠状面声像图特征表现为:低回声区、结构紊乱、微钙化(单纯或合并低回声),二维超声下未见明确占位效应,在冠状面引导下对病变区域行组织学穿刺活检,将穿刺病理与手术病理相对比,比较病理符合率,同时对恶性病例的声像图特征进行分析。结果穿刺结果恶性的为42例,发生率为34.15%,与手术病理完全符合为39例,3例出现低估(2.43%);良性的为81例,其中45例经手术切除,术后病理证实假阴性2例,其余病例经过1~2年随访,2例证实为恶性,假阴性率3.25%。ABVS声像图表现中,相比于单纯微钙化(4/16)及单纯低回声区(8/70),低回声区合并微钙化(30/37)病灶具有统计学意义(χ~2=51.277、15.276,P<0.05)。13例在冠状面上表现为“汇聚征”的穿刺活检均为乳腺癌。结论非肿块型乳腺癌在冠状面上具有一定的声像图特征,低回声区合并微钙化、结构紊乱呈“汇聚征”等,且病变区域更加直观,与体表投影一致,与常规超声引导下的穿刺活检相比,冠状位引导下的穿刺活检可以有效提高穿刺病理符合率,提高乳腺癌检出率。
Objective To investigate the value of breast biopsy under the guidance of coronary angiography in the diagnosis of non-lump breast lesions. Methods A retrospective analysis of 123 cases of non-lump breast lesions was performed by automatic total volume imaging of the breast. The features of the coronal sonography were as follows: hypoechoic region, structural disorder, micro-calcification (simple or combined hypoechoic), two-dimensional ultrasound Under the guidance of the coronal plane under the guidance of the lesion area line histological biopsy, the puncture pathology and surgical pathology compared to compare the pathological coincidence rate, while the malignant cases of the sonographic features were analyzed. Results The results of puncture were malignant in 42 cases, the incidence was 34.15%, in line with the surgical pathology of 39 cases, 3 cases were underestimated (2.43%); benign as 81 cases, of which 45 cases were surgically removed and confirmed by pathology False negative in 2 cases, the remaining cases after 1 to 2 years of follow-up, 2 cases confirmed as malignant, false negative rate 3.25%. In the ABVS sonography, the lesions in the hypoechoic area with microcalcification (30/37) were statistically significant (χ ~ 2 = 51.277, 15.276, P <0.05). Thirteen cases showed biopsy on the coronal plane as “confluence” and all were breast cancer. Conclusions The non-massional breast cancer has certain sonographic features on the coronal plane. The hypoechoic area is associated with microcalcifications and the structural disorder is “convergent sign ”. The lesion area is more intuitive and consistent with the body surface projection, Compared with the puncture biopsy guided by ultrasound, the biopsy guided by coronal can effectively improve the coincidence rate of puncture pathology and improve the detection rate of breast cancer.