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中华乳腺病杂志(电子版) ›› 2016, Vol. 10 ›› Issue (06) : 321 -325. doi: 10.3877/cma.j.issn.1674-0807.2016.06.001

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乳腺结节的评估、诊断及处理
王永南1, 王颀1,()   
  1. 1.510010 广州,广东省妇幼保健院乳腺病中心
  • 收稿日期:2016-08-29 出版日期:2016-12-01
  • 通信作者: 王颀

Evaluation, diagnosis and treatment of breast nodules

Yongnan Wang1, Qi Wang1,()   

  1. 1.Breast Disease Center,Women and Children's Hospital of Guangdong Province, Guangzhou 510010, China
  • Received:2016-08-29 Published:2016-12-01
  • Corresponding author: Qi Wang
引用本文:

王永南, 王颀. 乳腺结节的评估、诊断及处理[J/OL]. 中华乳腺病杂志(电子版), 2016, 10(06): 321-325.

Yongnan Wang, Qi Wang. Evaluation, diagnosis and treatment of breast nodules[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2016, 10(06): 321-325.

乳腺结节目前没有明确的定义。 一般而言,临床可扪及的乳腺肿物称之为乳腺肿块,反之,临床不可扪及而通过影像学发现的乳腺肿物称之为乳腺结节(breast nodules),大部分乳腺结节是超声检查发现且考虑良性的低回声病灶,常归为BI-RADS 3 级或4A 级。 乳腺结节是乳腺疾病诊治过程中经常遇到的临床问题,评估、诊断和处理均有争议,常采用BI-RADS 分级系统评估风险,并根据病情补充乳腺X 线检查(MG)和MRI 以减少漏诊,还应考虑病灶大小、硬度以及患者年龄等细化分级。 根据相关指南进行空芯针穿刺活组织检查(CNB)和真空辅助微创活组织检查(VAB)进行早期诊断。 乳腺结节评估和诊断临床数据的积累,将推动乳腺结节诊治的进步。

Breast nodules are currently not clearly defined. In general, clinical palpable breast lesions are called breast masses, while clinically non-palpable breast lesions which can be detected by imaging are called breast nodules. Most of the breast nodules are detected by ultrasonography and regarded as benign hypoechoic lesions, often classified as BI-RADS 3 or 4A. Breast nodules are often observed in the clinical diagnosis and treatment of breast disease. The assessment, diagnosis and treatment of breast nodules are controversial. We usually assess the risk using BI-RADS, and apply mammography and MRI to prevent missed diagnosis, and take the size and hardness of lesions and patients' age into consideration in clinical grading.According to the relevant guidelines, core-needle biopsy and vacuum-assisted breast biopsy can be used for early diagnosis. The accumulation of clinical data pertaining to the assessment and diagnosis of breast nodules will improve the treatment in the future.

图1 乳腺结节的评估诊断及处理流程图 注:VAB 表示真空辅助微创活组织检查;CNB 表示空芯针穿刺活组织检查;MG 表示乳腺X 线检查
[1]
Marmot MG, Altman DG, Cameron DA, et al. The benefits and harms of breast cancer screening: an independent review[J]. Br J Cancer,2013,108(11):2205-2240.
[2]
Sickles EA. Screening mammography and breast sonography[J]. AJR Am J Roentgenol,1994,163(2):469-470.
[3]
Groenendijk RP, ter Horst H,Tinnemans JG,et al. Critical analysis of the treatment of non-palpable breast cancer: toward a less invasive future? [J]. World J Surg,2002,26(3):285-289.
[4]
Gruber R, Jaromi S, Rudas M, et al. Histologic work-up of nonpalpable breast lesions classified as probably benign at initial mammography and/or ultrasound (BI-RADS category 3)[J]. Eur J Radiol,2013,82(3):398-403.
[5]
American College of Radiology. Breast imaging reporting and data systems (BI-RADSs) atlas[M].5th ed. Reston,VA:American College of Radiology,2013.
[6]
万舰,王永南,王颀,等. 乳腺影像报告与数据系统在超声检查可扪及乳腺肿块中的诊断价值[J/CD]. 中华乳腺病杂志:电子版,2010,4(4):381-388.
[7]
Kaplan C, Matallana R, Wallack MK. The use of state-of-the-art mammography in the detection of nonpalpable breast carcinoma[J].Am Surg,1990,56(1):40-42.
[8]
张安秦, 王颀, 朱彩霞,等. Mammotome 手术诊治乳腺不可触及病灶的研究[J]. 中国微创外科杂志,2009,9(1):24-26.
[9]
Meeuwis C,Mann RM,Mus RD,et al.MRI-guided breast biopsy at 3T using a dedicated large core biopsy set: feasibility and initial results[J]. Eur J Radiol,2011,79(2):257-261.
[10]
Fan L, Strasser-Weippl K, Li JJ, et al. Breast cancer in China[J].Lancet Oncol,2014,15(7): e279-289.
[11]
王立平, 蒋天安, 杨琛, 等. 乳腺良性结节超声BI-RADS 分级的可靠性及其影响因素分析[J]. 中华超声影像学杂志, 2011,20(4):314-317.
[12]
王永南, 王颀, 张安秦, 等. 真空辅助旋切微创术对超声检查良性乳腺实性肿块的诊治价值[J/CD]. 中华乳腺病杂志:电子版,2010,4(4):403-409.
[13]
陈燕, 张江宇, 马小燕, 等. 超声BI-RADS 分级在乳腺肿块诊断中的应用[J/CD]. 中华临床医师杂志:电子版,2013,7(6):2421-2424.
[14]
吴玲,王颀,连臻强,等.超声BI-RADS 3 级乳腺不可扪及病变的微创活组织检查[J/CD]. 中华乳腺病杂志:电子版,2012,6(2):147-152.
[15]
Liberman L, Mason G, Morris EA, et al. Does size matter? Positive predictive value of MRI-detected breast lesions as a function of lesion size[J]. AJR Am J Roentgenol,2006,186(2):426-430.
[16]
Berg WA, Blume JD, Cormack JB, et al. Lesion detection and characterization in a breast US phantom: results of the ACRIN 6666 Investigators[J]. Radiology,2006,239(3):693-702.
[17]
Brem RF, Hoffmeister JW, Zisman G, et al. A computer-aided detection system for the evaluation of breast cancer by mammographic appearance and lesion size[J]. AJR Am J Roentgenol,2005,184(3):893-896.
[18]
张琼, 姜玉新, 朱庆莉, 等. 病灶大小对触诊不清的乳腺恶性病灶超声检出率的影响[J]. 中国医学科学院院报, 2011, 33(2):136-141.
[19]
Ophir J,Céspedes I,Ponnekanti H,et al. Elastography:a quantitative method for imaging the elasticity of biological tissues[J]. Ultrason Imaging,1991,13(2):111-134.
[20]
李岩玲,朱玲,蔡婷婷. BI-RADS 评级标准联合超声弹性成像评分对乳腺肿块良恶性鉴别诊断的价值[J]. 中国临床医学影像杂志,2014,25 (4):277-279.
[21]
Liu H, Jiang Y, Dai Q, et al. Differentiation of benign and malignant sub-1-cm breast lesions using contrast-enhanced sonography[J]. J Ultrasound Med,2015,34(1):117-123.
[22]
张丽丹, 包凌云, 张丽. ABVS 在乳腺多发结节中偶发癌的诊断价值[J]. 中国超声医学杂志,2014,30 (7):599-602.
[23]
Zheng FY, Yan LX, Huang BJ, et al. Comparison of retraction phenomenon and BI-RADS-US descriptors in differentiating benign and malignant breast masses using an automated breast volume scanner[J].Eur J Radiol,2015,84(11):2123-2129.
[24]
Markopoulos C, Kouskos E, Revenas K, et al. Open surgical biopsy for nonpalpable breast lesions detected on screening mammography[J].Eur J Gynaecol Oncol,2004,26(3):311-314.
[25]
Boerner S, Fornage BD, Singletary E, et al. Ultrasound-guided fineneedle aspiration(FNA) of nonpalpable breast lesions: a review of 1885 FNA cases using the National Cancer Institute-supported recommendations on the uniform approach to breast FNA[J]. Cancer,1999,87(1):19-24.
[26]
Pisano ED, Fajardo LL, Tsimikas J, et al. Rate of insufficient samples for fine-needle aspiration for nonpalpable breast lesions in a multicenter clinical trial: the Radiologic Diagnostic Oncology Group 5 Study. The RDOG5 investigators[J]. Cancer,1998,82(4):679-688.
[27]
Barra AA, Gobbi H, de L Rezende CA, et al. A comparision of aspiration cytology and core needle biopsy according to tumor size of suspicious breast lesions[J]. Diagn Cytopathol,2008,36(1):26-31.
[28]
Farshid G, Downey P, Pieterse S, et al. Effectiveness of core biopsy for screen-detected breast lesions under 10 mm: implications for surgical management[J]. ANZ J Surg, 2015,doi: 10. 1111/ans.13037.
[29]
Nakano S, Otsuka M, Mibu A, et al. Significance of fine needle aspiration cytology and vacuum-assisted core needle biopsy for small breast lesions[J]. Clin Breast Cancer,2015,15(1): e23-26.
[30]
Lacambra MD, Lam CC, Mendoza P, et al. Biopsy sampling of breast lesions: comparison of core needle-and vacuum-assisted breast biopsies[J]. Breast Cancer Res Treat,2012,132(3):917-923.
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