乳腺微创活检 - 让我们宠爱自己的乳房,# 02-0734, 2002 Ethicon Endo-Surgery, Inc., Cincinnati, OH 45242,2,Outline 内容,Breast Cancer . . . Facts & Figures乳腺癌介绍 Breast Cancer . . . Detection & Diagnosis乳腺癌的发现和诊断 Biopsy Options 活检的方法 Open Surgical 开放手术活检 Fine Needle Aspiration 细针抽吸活检 Core Needle 粗针穿刺活检 Mammotome 麦默通穿刺活检,Why are we here? 我们为何在此？,# 02-0734, 2002 Ethicon Endo-Surgery, Inc., Cincinnati, OH 45242,Breast Cancer 乳腺癌,5,Breast cancer,Excluding cancers of the skin, breast cancer is the most common cancer among women, accounting for nearly one out of every three cancers diagnosed in American women. 乳腺癌已经成为第一位妇女恶性肿瘤,American Cancer Society Breast Cancer Facts & Figures 2001-2002,6,Breast Cancer,在中国，乳腺癌的发病率 29/100000 沿海地区高于内陆地区 上海：51/100000 北京：40/100000,7,Risk of breast cancer increases with age,Feuer EJ, Wun LM. DEVACN: Probability of Developing or Dying of Cancer. Version 4.0 Bethesda, MD: National Cancer Institute 1999,Facts & Figures,8,乳腺癌5年生存率,9,Breast Cancer,乳腺癌或者卵巢癌的病史 乳腺癌的家族史既往乳腺活检提示有不典型增生，或者导管原位癌 12岁之前月经初潮 55岁之后绝经 未生育 30岁之后生育第一胎 BRCA1 or BRCA2 乳腺癌基因突变 每日饮酒 肥胖 （绝经后体重增加明显）,危险因素,Facts & Figures,10,Breast Cancer Detection,Breast cancer, when it is most treatable, typically does not produce any symptoms 乳腺癌在其治疗最佳阶段时，往往没有任何症状,American Cancer Society Breast Cancer Facts & Figures 2001- 2002,American Cancer Society Guidelines for the Early Detection of Breast Cancer in Asymptomatic Women 美国癌症学会乳腺癌早期诊断指南要求没有症状的妇女 Age 20-39Clinical breast examination every three (3)years每三年进行临床检查Monthly breast self-examination每月乳房自检 Age 40 and overAnnual mammogram每年做鉬钯摄片Annual clinical breast examination每年临床体检Monthly breast self examination每月自检,11,Can breast cancer be prevented? 乳腺癌可以被预防吗？,12,If breast cancer is detected in its earliest stage, there is a much better chance of survival 如果乳腺可以早期发现，病人生存率可以大大提高。,13,Breast Self Exam BSE 自检Clinical Breast Exam CBE 临床检查 Breast ultrasound 乳腺超声Mammography 乳腺X光摄片Screening 常规摄片Diagnostic 诊断摄片,Breast Cancer Detection 乳腺癌的发现,14,To make a definitive diagnosis about whether a breast abnormality is benign or malignant, a biopsy must be performed. 乳腺疾病的性质必须由活检来确认,80% are benign 80%的活检结果是良性的,Breast Cancer Diagnosis,Brown ML, Houn F, Sickles EA, et al. Screening Mammography in community practice; positive predictive value of abnormal findings and yield of diagnostic procedures. AJR Am J Roentgenol 1995; 165: 1373-77,Biopsy Options 活检方法,16,Biopsy Options,Mammotome Breast Biopsy 麦默通,Core Needle Breast Biopsy 粗针穿刺,Open Surgical Breast Biopsy,Minimally Invasive 微创乳腺活检,Invasive 开放活检,Knowing your biopsy options can help you gain a definitive diagnosis while minimizing pain, scarring and recovery time,Biopsy Options Invasive 开放手术活检,18,Open Surgical Biopsy,Biopsy Options,Performed in the Operating Room 在手术室进行An incision is made in the breast and a large tissue sample is cut and removed在乳房作切口，取出大块组织 In some cases, a wire is inserted into the breast to aid in localizing the abnormality 某些情况下, 需要进行金属钩/丝定位病变组织Possible scarring and disfiguration that can interfere with future mammograms可能留下疤痕和乳房变形，影响以后摄片效果,19,Open Surgical Biopsy,Biopsy Options,General or local anesthesia with sedation 全麻或局麻Sutures 需要缝合Possible scarring and disfiguration that can interfere with future mammograms 有疤痕和乳房变形,Biopsy Options Minimally Invasive 微创乳腺活检,21,Minimally Invasive 微创活检,Reduced morbidity减少创伤No post-procedure disability 无术后活动不便Improved cosmesis美容效果好Eliminates distortion of breast tissue that might make interpretation of a mammogram difficult 无乳腺组织变形。Permits optimal preoperative planning when there is a definitive diagnosis of cancer确切的肿瘤诊断结果使充分的术前诊断成为可能。,Biopsy Options,22,Stereotactic (x-ray) guided biopsy 立体定位（x-线）引导乳腺活检,Locates the abnormality in the breast in three dimensions (horizontal, vertical, depth).三维立体定位Uses the same visual principles that our brain and our eyes use to see in three dimensions.三维定位病灶,23,Ultrasound-guided biopsy 超声引导乳腺活检,Locates the abnormality in the breast using high frequency sound waves.使用高频声波定位乳腺病变组织,FNA 细针抽吸,25,Biopsy Options,Can be performed in an outpatient setting or doctors office 门诊进行No anesthesia无需麻醉No sutures无需缝合Several needle insertions to collect fluid and/or cellular material多次穿刺收集液体和细胞 Cyst aspiration for fluids 囊液抽吸Unable to mark biopsy site 无法标记活检部位,Fine Needle Aspiration (FNA),26,Cytology vs. Histology细胞病理Requires a Cytopathologist and Cytotechnologist需要细胞病理专家Significant insufficient sampling (2% - 36%)*标本严重不足Unable to differentiate in-situ from invasive*无法区分原位癌和浸润性癌,Biopsy Options,* Jackson VP, Bassett, LW Stereotactic fine-needle aspiration biopsy for nonpalpable breast lesions. AJR AM J Roentgenol 1990; 154:1196-97,*Masood S. Occult breast lesions and aspiration biopsy: a new challenge. Diagn Cytopathol 1993; 9:613-14,FNA,Core Needle 粗针穿刺,28,Biopsy Options,Core Needle Biopsy,Can be performed in an outpatient setting or doctors office 可在门诊进行Local anesthesia 局麻No sutures 无需缝合4 6 needle insertions to collect a sufficient amount of breast tissue for an accurate diagnosis 多次穿刺以收集足够乳腺组织进行准确诊断Unable to mark biopsy site无法标记活检部位,