Clinical Study Of Ultrasound-guided Minimally Invasive Biopsy System For Benign Breast Lumps

Objective：1.To evaluate the value of ultrasound-guided handheld vacuumminimally invasive biopsy system in the removal of benign breast lesions.2. The guiding role of BIRADS grading standards in selecting cases for breastinvasive biopsy therapyMethods：From August2012to August2013， a total of150female patients(range16-55years old， average age of46.7±5.5)with423lesions were treated withultrasound-guided minimally invasive biopsy system in out department.78casesmanifested by bilateral breast with single or multiple nodules，35cases unilateralbreast with solitary nodule，37cases unilateral breast solitary nodule， and96lesionswere palpable. The major clinic signs included breast tenderness， Sense or palpable ofmass.According to BIRADS grading standards and diameter of the lesions we dividedthe cases into two groups. Of the312lesions，111were in BIRADS Ⅲ grade.Diameter: D=10mm259cases，10mm <D≤20mm141cases，20mm <D≤30mm23cases. The nodules we select were in BIRADS Ⅱ-Ⅲ grade only， and the diameter ofwhich were3-30mm， with an average of18.7±4.8mm.Before the treatment all the nodules were observated with the ultrasoundcooperated with mammography and other imaging studies if necessary. According to BIRADS grading standards， the cases we select were in BIRADS Ⅱ-Ⅲ grade， lessthan30mm in diameter. If the nodule is in grade BIRADⅢ， there is less than a2%chance that the patient will have a malignant tumor. Prior to the treatment， wecommunication with the patient and family on the pros and cons，and informed consentwas obtained from each patient. Laboratory tests included liver and kidney functions，coagulation function were checked， and every patient must be examined to check ifanticoagulants were taken.The patient was placed in the supine position with the hands on the head to fullyexposed bilateral breast.If the tumor was located near the outside，patients were requestto take the lateral decubitus position with a small pillow in the rear. All patientsunderwent the ultrasound examination and an appropriate puncture route was chosen onultrasound Local anesthesia with2%lidocaine was performed subcutaneously on thepuncture site. If there were multiple nodules in unilateral breast， removing multiplelesions in one approach was required to reducing breast duct injury. And we usuallyinjected a mixture of lidocaine and physiological saline solution at the base of thenodule and needle route with a20ml syringe and22G PTC cannula.The ultrasound wasused in the whole treatment to guid the adjustment of the puncture route to achievecompletely resection. Chest was bundled with elastic bandage for24hours.Imaging follow-up were conducted1，6and12months after treatment to determinewheather there were residual or recurrent nodules or not.Compare the advantages and disadvantages between the minimally invasive surgeryand open surgery on the aspects such as diameter of the skin wound， amount ofbleeding， edema time of surrounding tissue， time of wound closing， length ofhospital stay， the number of lesions of one treatment and scar size.Results：1.423benign lesions were completely removed with the minimallyinvasive biopsy system. No residual tumor tissues or procedure-related majorcomplications were observed. At the final pathological diagnosis in BIRADSⅡgrade307(98.4%) nodules were benign， and5benign lesions combined with atypicalhyperplasia; in BIRADSⅡgrade109(98.2%)，1benign lesions combined with atypical hyperplasia，1mergerd with intraductal carcinoma. All lesions found by ultrasound canbe completely removed. Nodules D≤10mm，10mm <D≤20mm were completeresected with no serious complications， and lesions20mm <D≤30mm also werecompletely removed， one of which presented arteriovenous fistula. Patients withbenign lesions combined with atypical hyperplasia and mergerd with intraductalcarcinoma had mammectomy shortly after the treatment. Histological examinationshowed no abnormal tissue was confirmed in the residual cavity.2.1，6and12months imaging follow-up showed no recurrence in the originallesion area. One patient with single nodular was discovered a regenerative nodule on the12-month ultrasound follow-up.3.Complications:treatment was suspended on3patients because of bleeding， andafter a local pression of15minutes， the operation continued. Among all the cases，5cases residual cavity hemorrhage，2cases skin plaque， and they were recovered3months，2months after the treatment respectively.4. Compared with the open surgery， minimally invasive biopsy has obviousadvantages such as less bleeding，small skin incision， removal all lesions showed by ultrasound，surgical trauma， shorter hospital stay， a small scar and high patient satisfaction.Conclusion：1.Ultrasound-guided minimally invasive biopsy system is a verysimple， effective and safe treatment for the benign breast nodules， even can be usedas the preferred method for removal of some benign breast lesions.2.BIRADS grading standards can standardize the preoperative patient selection，and can be used as a reliable guide standard for selecting cases.