Biopsija dojke širokom iglom vođena tomosintezom – prikaz metode i vlastitih rezultata

Kristina Samaržija, Ines Kolar, Zoran Jurjević

Perkutana biopsija širokom iglom minimalno je invazivna metoda koja omogućava preoperativnu histološku dijagnozu promjena u dojci. Kod nepalpabilnih promjena izvodi se pod kontrolom radioloških slikovnih metoda. Neke promjene vidljive tomosintezom nisu uočljive 2D mamografijom i ne mogu se bioptirati konvencionalnom stereotaksijskom metodom. Stoga je 2013. godine u kliničku praksu uvedena biopsija vođena tomosintezom. Ta se metoda služi slojevnim snimkama za definiranje dubine promjene, bez potrebe za dodatnim snimanjem i triangulacijom. Postupak se izvodi s manjim brojem ekspozicija i stoga s nižom ukupnom dozom zračenja te kraće od stereotaksijske biopsije. U Općoj bolnici Karlovac metoda se primjenjuje od kraja 2015. godine, otkad je učinjeno 179 zahvata. Ciljanje i uzimanje uzoraka bili su uspješni kod svih promjena, što je potvrđeno kontrolnom tomosintezom ili snimanjem uzoraka pri promjenama s kalcifikatima. Patohistološkom analizom dobiveni su 44 (24,6%) maligna nalaza, 13 (7,3%) benignih promjena nesigurnoga malignog potencijala te 122-je (68,2%) benigne promjene. Među malignim nalazima bili su 32 (72,7%) neinvazivna duktalna karcinoma (DCIS) i 12 (27,3%) invazivnih karcinoma. S obzirom na konačnu dijagnozu, nakon kirurškog zahvata imali smo stopu podcijenjenosti DCIS-a od 14,3%, a benignih promjena nesigurnoga malignog potencijala od 25%. Benigne promjene praćene su tijekom razdoblja od 24 mjeseca. U uzorku sa završenim periodom praćenja stopa lažno negativnih nalaza bila je 2,8%, osjetljivost metode 86,4%, specifičnost 100%, pozitivna prediktivna vrijednost 100%, negativna prediktivna vrijednost 70%, a točnost 89,7%. Za vrijeme postupka i nakon njega nismo imali većih komplikacija. Biopsija dojke vođena tomosintezom nije rezervirana samo za promjene vidljive jedino tomosintezom već se može primijeniti i za vođenje biopsija promjena koje su vidljive 2D mamografijom.

Percutaneous breast core biopsy is a minimally invasive method which allows preoperative histologic diagnosis of breast lesions. If the lesions are nonpalpable, it is performed under imaging guidance. Some lesions detected with digital breast tomosynthesis are occult in 2D mammography and cannot be biopsied in conventional stereotactic mode. Therefore, in 2013 tomosynthesis guided breast biopsy was introduced into clinical practice. It uses tomosynthesis views to define the depth of the lesion, without additional projections and triangulation. The procedure is performed with fewer x-ray exposures and therefore with a lower total radiation dose and overall procedure time comparing with stereotactic biopsy. This method has been used in General Hospital Karlovac since 2015, and during this time 179 procedures were done. Targeting and sampling of the lesions were successful in all cases, as confirmed by the postprocedural tomosynthesis or specimen radiograph for lesions with calcifications. Of the 179 lesions, the histologic diagnoses were malignant in 44 (24.6%) cases, lesions of uncertain malignant potential have been found in 13 (7.3%) cases and benign lesion in 122 (68.2%) cases. Among malignant lesions there were 32 (72.7%) ductal carcinomas in situ (DCIS) and 12 (27.3%) invasive carcinomas. Compared with final diagnosis at surgery, the underestimation rate was 14.3% for DCIS and 25% for lesions of uncertain malignant potential. Benign lesions were followed-up for 24 months. In the sample with the completed period of monitoring, the rate of false negative findings was 2.8%, sensitivity of the method was 86.4%, specificity 100%, positive predictive value 100%, negative predictive value 70%, and accuracy 89.7%. There were no major complications during and after the biopsies. Tomosynthesis guided breast biopsy is not limited only to lesions visible exclusively by this method, but can be used to guide biopsies in patients with lesions visible also in 2D mammography.