| Objective: Discuss the clinical application in the diagnosis of nonpalpable breast microcalcification lesions with the stereotactic core needle biopsy and stereotactic needle localized biopsy.Thus we could further improve and perfect the technology in stereotactic positioning of nonpalpable breast microcalcification lesions.And also we could optimize its operational process,lift the doubt of sampling accurately by clinicians and patients.Through the analysis of different forms and distribution characteristics of nonpalpable breast microcalcification lesions in X-ray examination,we could summarize the key points of the nature of the lesions and improve the diagnostic rate of the early breast cancer.Methods: 83 lesions in 79 patients were collected from January 2015 to January 2016 in the breast center of the Fourth Hospital of Hebei Medical University.All of these patients had no significant abnormalities but the nonpalpable breast microcalcification lesions.And these patiens was classified into 3 categories ~4B categories by BI-RADS.X-ray examination was performed in 79 patients by German Mammomat Novation DR Siemens full digital mammography.These patients was carried on CC position and MLO position of bilateral breast and ML position of diseased breast to check.The morphology and distribution of microcalcifications were observed and recorded of the X-ray manifestations in 83 lesions.Stereotactic core needle biopsy was performed in 26 patients and stereotactic needle localized biopsy in 53 patients by its matching digital stereotactic positioning system.And all specimens were diagnosed pathologically.The various tissue strips of the patients who got stereotactic core needle biopsy needed to be rechecked.And analyzing the probability of microcalcifications in each tissue strips in order to eliminate the question whether the specimen was extracted accurately by patients and physicians.So we could optimize the times of biopsy.The microcalcifications which got by stereotactic needle localized biopsy need to recheck after local excision.This was the evidence that whether the microcalcifications was completely resected.And analyzing the correlation between pathological results and the X-ray image of microcalcifications.The data were recorded by Excel 2007,and SPSS 21 software was used for statistical analysis.Result:1 There were 30 lesions in 26 patients who were female underwent stereotactic core needle biopsy.The age of the patiens was 25~53 years old,and the average age was 42.4 years old.In all lesions,20 of the left breast,and 10 of the right.2 The BI-RADS classification of the core needle biopsy patiens was the 3 category accounted for 36.7%(11/30),the category 4A accounted for 40%(12/30),and the category 4B accounted for 23.3%(7/30).The morphology of microcalcifications was mainly coarse type(46.7%,14/30)and small fuzzy type(40%,12/30),and the distribution of microcalcifications was clustered(60%,18/30).3 The breast which got core needle biopsy was taken 4 times in each case and the tissues needed to got the X-ray examination.While 7 cases were not found the calcifications in all tissue strips,and the positive rate was 76.7%(23/30).In the 4 tissues,the rates of calcifications were the first accounted for 82.6%(19/23),the second accounted for 91.3%(21/23),the third accounted for 73.9%(17/23)and the fourth accounted for 56.5%(13/23).And the comparison was P < 0.05 between groups,so the difference was statistically significant.4 The pathologic diagnosis of 26 cases,who got stereotactic core needle biopsy,was benign.5 All of the 53 cases who got stereotactic needle localized biopsy were female.The age was 28~72 years old,and the average age was 46.8 years old.And the left breast lesions were 28,the right breast lesions were 25.6 The BI-RADS classification who got stereotactic needle localized biopsy was most for the 4A class(77.4%,41/53).In the X-ray image,the shape of microcalcifications was mainly dominated by coarse and uneven type(32.1%,17/53)and small fuzzy type(37.7%,20/53),and the microcalcifications was mainly distributed in clusters(96.2%,51/53).7 The pathological results after surgical resection of 53 cases were a total of 8 cases of malignant,accounting for 15.1%(8/53)and a total of 45 cases of benign,accounting for 84.9%(45/53).8 In 53 cases who got stereotactic needle localized biopsy,49 cases were successfully located and the success rate was 92.5%(49/53).The results of X-ray examinaton showed that 47 cases were operated successfully in one time,and the satisfaction rate was 88.7%(47/53).9 There were 83 lesions in 79 cases got the stereotactic core needle biopsy or stereotactic needle localized biopsy.All of them were female.The age was 25~72 years old,and the average age was 45.4 years old.Among the lesions 48 in left while 35 in right.10 In nonpalpable breast microcalcification lesions the benign was 75 while the malignant was 8.The positive rate of the early breast cancer was 9.6%(8/83).And the BI-RADS classification was most for the 4A class(69.9%,58/83).11 In the X-ray image of the 83 lesions,the shape of microcalcifications was mainly dominated by coarse and uneven type 38.7%(29/75)and small fuzzy type 41.3%(31/75).In the malignant lesions the polymorphic type was 3,coarse uneven type was 1,and each of the fine fuzzy type and amorphous type was 2.In the benign lesions,the microcalcifications was mainly distributed,and the proportion was 81.3%(61/75).While in the malignant lesions,all of the 8 showed cluster distribution.Conclusion:1 The tissue was rechecked by the X-ray after stereotactic core needle biopsy to clear whether containing microcalcifications.It was the evidence of sampling accurately and pathologic results were reliable.Dispel the concerns of patients and clinicians on the accuracy of the sampling.2 The probability of various organizations which contain microcalcifications after stereotactic core needle biopsy,the first 3 ratio was far higher than the fourth.Therefore,it could be appropriate to reduce the number of biopsy,and 3 needles can be punctured in different directions to the target point.3 The stereotactic core needle biopsy was easyly to operate and accurately positioning.And the low grade malignant,such as class 4 A and some class 3,could be used as the first choice for qualitative diagnosis.But there was a certain false negative rate.Therefore,we need to follow up regularly to prevent the missed diagnosis.4 The stereotactic needle localized biopsy was conducive to the complete removal of calcified lesion.For patients with suspected malignant lesions could also play the purpose of diagnosis and treatment.And it would not cause tumor metastasis.5 Nonpalpable breast lesions with microcalcification as the main sign,there was no significant difference in the morphology and the BI-RADS classification.It was very difficult to distinguish the pathological changes of the lesions by the performance of the breast X-ray alone.6 The application of X-ray stereotactic core needle biopsy and stereotactic needle localized biopsy provides a good method for the qualitative diagnosis and treatment of nonpalpable breast lesions.Through the reasonable selection and application of stereotactic core needle biopsy and stereotactic needle localized biopsy can improve the diagnosis of early breast cancer. |
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