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目的:探讨钼靶X线引导下钢丝定位手术切检技术在乳腺不可触及病变(NPBL)的应用技巧和临床价值。方法:对64例钼靶X线片上NPBL患者,利用二维定位装置在X线引导下穿刺留置带钩钢丝,在钢丝引导下手术切检。切除标本X线摄影后行术中快速病理组织学检查,根据病理结果决定进一步手术或结束手术。结果:64例患者定位准确,手术完整切除病变。病理结果为良性病变50例,乳腺癌14例,其中导管原位癌7例,行保乳术3例,行乳房全切+前哨淋巴结活检4例,浸润性导管癌6例,行保乳术2例,改良根治术4例,髓样癌1例,行改良根治术。结论:合理的钢丝定位及切检技巧可提高切除病变的准确性,对乳腺X线发现的BI-RADS 4类及5类NPBL进行钢丝定位手术切检能明确病变性质、提高早期乳腺癌检出率。
Objective: To explore the application skills and clinical value of mammography guided X-ray guided wire positioning in non-palpable lesions of the breast (NPBL). Methods: Sixty-four patients with NPBL on mammography were divided into two groups according to the direction of X-ray. After removal of the specimen X-ray examination intraoperative rapid pathological examination, according to the pathological findings decided to further surgery or surgery. Results: 64 patients with accurate positioning, complete removal of the lesion surgery. Pathological findings of benign lesions in 50 cases, 14 cases of breast cancer, including ductal carcinoma in situ in 7 cases, breast conservation surgery in 3 cases, breast total resection + sentinel lymph node biopsy in 4 cases, invasive ductal carcinoma in 6 cases, breast conservation surgery 2 cases, modified radical mastectomy in 4 cases, medullary carcinoma in 1 case, modified radical mastectomy. Conclusion: The reasonable technique of wire orientation and incision detection can improve the accuracy of excision. The biopsy of BI-RADS type 4 and 5 NPBL detected by mammography can confirm the lesion character and improve the detection of early breast cancer rate.