Nyob rau hauv cov saw ntawm kev kuaj mob ntxov thiab kev kho mob qog noj ntshav mis, mis biopsy yog qhov txuas tseem ceeb uas txuas qhov sib txawv ntawm kev tshuaj ntsuam xyuas thiab kev kuaj mob pathological. Nws txuas cov "kev ua xyem xyav" txheeb xyuas los ntawm kev tshuaj ntsuam xyuas thiab ua rau "cov pov thawj tseeb" ntawm kev kuaj mob pathological. Lub mis biopsy koob yog cov cuab yeej tseem ceeb uas ua tiav qhov kev hloov pauv no. Nws daim ntawv thov kev kho mob tau nthuav dav los ntawm qhov kev kuaj sim yooj yim mus rau kev kho mob resection, kev ntsuas kev ua tau zoo, thiab txawm tias kev tshawb fawb molecular pathological, muab kev txhawb nqa rau kev tswj xyuas cov kab mob ntawm lub mis.

Core Diagnostic Scenario: Los ntawm Suspicious Lumps mus rau qhov chaw nkaum

Kev ntsuam xyuas ntawm palpable masses:Rau cov mis loj uas tau kuaj pom los ntawm cov neeg mob tus kheej - kev kuaj xyuas lossis kws kho mob palpation, ultrasound-guided hollow needle biopsy (CNB) lossis nqus tsev vacuum-pab biopsy (VABB) yog cov kev nyiam rau kev kuaj mob. Nws tuaj yeem txiav txim siab qhov zoo lossis qhov tsis zoo ntawm qhov loj thiab zam qhov tsis tsim nyog kev phais.

Localization thiab sampling ntawm microcalcification foci:Clustered microcalcifications kuaj pom los ntawm mammography yog cov cim tseem ceeb ntawm kev mob qog noj ntshav thaum ntxov, tshwj xeeb tshaj yog ductal carcinoma in situ (DCIS). Cov ntsiab lus calcification no feem ntau tsis palpable. Cov txheej txheem VABB tau coj los ntawm kev ua haujlwm stereotactic plays lub luag haujlwm tseem ceeb. Lub kaw lus xam qhov peb - qhov sib koom ua ke ntawm calcification foci los ntawm lub khoos phis tawj thiab coj cov koob tshuaj biopsy rau qhov piv txwv rotary kom tau txais cov ntaub so ntswg uas muaj calcification, nrog rau qhov kev kuaj mob siab heev.

Sib txawv ntawm complex cysts thiab khoom nodules:Cov kab mob echogenic sib xyaw nrog cov cystic thiab cov khoom muaj nyob hauv ultrasound muaj qhov tsis meej. Fine needle aspiration (FNAB) tuaj yeem nqus cov kua dej sai sai rau kev kuaj cytological, thaum CNB lossis VABB tuaj yeem ua piv txwv cov khoom kom ua tiav qhov sib txawv.

Kev ntsuam xyuas ntawm lub txiv mis tawm:Rau unilateral, ib qho - qhov ntshav los yog cov kua txiv mis tawm, nws feem ntau qhia tias muaj qhov txhab nyob hauv cov ducts. Biopsy nyob rau hauv ductoscopy los yog lub hom phiaj puncture ntawm lub dilated ducts yuav nrhiav tau thiab tau txais epithelial hlwb los yog cov ntaub so ntswg los ntawm cov kab mob.

Saib xyuas qhov ua tau zoo ntawm kev kho neoadjuvant:Rau kev mob qog noj ntshav hauv zos, kev kho mob ua ntej neoadjuvant lossis kev kho mob tau dhau los ua tus txheej txheem txheej txheem. Hauv nruab nrab ntawm kev kho mob, CNB lossis VABB tuaj yeem rov ua dua ntawm qhov qub qhov txhab rau kev kuaj ntshav. Los ntawm kev ntsuam xyuas kab mob (xws li Miller-Payne grading) thiab kev hloov pauv hauv cov cim molecular, cov qog cov lus teb rau kev kho mob tuaj yeem raug ntsuas raws sijhawm, muab lub hauv paus rau kev kho cov tswv yim kho mob tom ntej.

Tshaj li Kev Ntsuas: Kev Kho thiab Kev Tshawb Fawb Tus Nqi ntawm Biopsy Needles

Niaj hnub nimno lub mis biopsy koob, tshwj xeeb tshaj yog cov kab ke VABB, muaj kev kho kom zoo. Rau cov qog me me uas muaj peev xwm ua tau zoo raws li kev txiav txim siab los ntawm kev kuaj pom (xws li fibroadenomas), cov neeg mob uas xav tau ncaj qha mus rau qhov qis qis qis rau kev tshem tawm kom tiav siv VABB. Qhov kev phais tsuas yog ib qho puncture point caws pliav kwv yees li 3-5 millimeters loj, ua tau raws li cov neeg mob ob qho kev xav tau rau kev zoo nkauj thiab tsawg. Lub Revolve ™ ST system ntawm TAVICOM, ntawm lwm tus, yog tsim tshwj xeeb rau cov kev kuaj mob resection.

Qhov tseem ceeb tshaj, cov ntaub so ntswg tau los ntawm biopsy yog cov ntaub ntawv tseem ceeb rau kev ntaus ntawv molecular thiab kuaj caj ces. Los ntawm immunohistochemical kuaj pom ntawm biopsy kuaj (ER, PR, HER2, Ki-67), molecular subtypes ntawm mob qog noj ntshav mis (Luminal A/B hom, HER2 overexpression type, triple- yam tsis zoo) tuaj yeem txiav txim siab. Qhov no yog lub hauv paus tseem ceeb rau kev tsim cov phiaj xwm kho tus kheej (kev kho mob endocrine, hom phiaj kho mob, kws khomob). Tsis tas li ntawd, siv cov ntaub so ntswg biopsy rau ntau cov noob caj noob ces (xws li Oncotype DX, MammaPrint) tuaj yeem ntsuas qhov kev pheej hmoo ntawm kev rov tshwm sim dua thiab qhia seb puas yuav tsum tau siv tshuaj khomob, ua tiav "cov tshuaj muaj tseeb".

Kev sib koom ua ke ntawm Kev Qhia Txuj Ci: Ua Cov Ntsiab Lus "muaj Qhov Muag"

Daim ntawv thov tseeb ntawm cov koob tshuaj biopsy yog cais tsis tau los ntawm kev txhim kho sai ntawm cov duab qhia kev siv tshuab. Ultrasound kev taw qhia yog tiag tiag- sij hawm thiab tsis yog - radiative, ua rau nws nyiam xaiv rau feem ntau siv tau los yog ultrasound- pom qhov txhab. Mammography stereotactic positioning yog tus qauv kub rau kev kuaj mob zais microcalcifications. Thaum cov kev taw qhia sib nqus resonance (MRI) lub hom phiaj tsuas yog pom ntawm MRI, txawm hais tias cov thev naus laus zis nyuaj thiab raug nqi, nws yog qhov tseem ceeb rau kev tshuaj xyuas cov neeg muaj kev pheej hmoo siab. Cov txheej txheem thev naus laus zis tshiab tshaj plaws yog kev sib koom ua ke ntau txoj hauv kev (xws li ultrasound thiab MRI) rau kev taw qhia, ua tiav cov txiaj ntsig zoo ntxiv thiab txhim kho qhov raug qhov tseeb mus rau qib millimeter.

Kev xyaum kho mob tau teeb tsa cov kev xav tau ntau dua rau kev ua haujlwm ntawm cov koob tshuaj biopsy: kev kuaj kom txaus (kom tsis txhob muaj qhov tsis txaus ntseeg), kev ua haujlwm yooj yim (kom txo qhov kev kawm nkhaus), tus neeg mob kev nplij siab (kom txo qhov mob thiab kev ntxhov siab), thiab tus nqi- ua tau zoo. Cov neeg tsim khoom xws li Hologic (nrog rau lawv cov Mammotome system) thiab BD (nrog lawv cov Vacora® system) tau ua kom zoo dua cov khoom tsim, piv txwv li, los ntawm kev siv cov koob thinner diameters, cov qauv nrawm dua, thiab cov qauv kev tswj hwm ntse dua, txhua tus tsom mus rau kev ua tau zoo dua cov kev xav tau ntawm kev kho mob.

Nyob rau hauv cov ntsiab lus, lub mis biopsy koob tau hloov zuj zus los ntawm ib qho yooj yim sampling cuab tam rau hauv ib tug multifunctional platform uas integrates meej kev kuaj mob, minimally invasive kev kho mob, kev ntsuam xyuas ua tau zoo, thiab kev tshawb fawb soj ntsuam. Nws ua haujlwm ua tus choj txuas cov duab tsis txaus ntseeg thiab kev pom zoo ntawm pathological, thiab yog ib qho cuab yeej tseem ceeb rau kev siv cov kev kho mob zoo rau cov kab mob ntawm lub mis.