中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (06): 698-701.DOI: 10.19538/j.cjps.issn1005-2208.2025.06.17

• 论著 • 上一篇    下一篇

中国乳腺病灶真空辅助旋切手术临床应用现状调查报告

薛渊博1，孙嘉鸿1，徐    虎1，王    水2，刘荫华3，王建东1    

  1. 1中国人民解放军总医院第一医学中心普通外科医学部乳腺外科，北京100853；2江苏省人民医院乳腺外科，江苏南京210029；3北京大学第一医院甲状腺乳腺外科，北京100034
  • 出版日期:2025-06-01 发布日期:2025-07-01

  • Online:2025-06-01 Published:2025-07-01

摘要： 目的    调查中国乳腺病灶真空辅助旋切手术（VABB）在临床实践中的应用现状，评估不同超声分级病灶的术后病理分布及不同类型医院的诊断差异，为规范化推广和早期诊断提供依据。方法    采用问卷调查方式，收集2023年1月1日至2023年12月31日期间，中国39家医院经治的超声分级Ⅲ-Ⅳ类乳腺结节［依据乳腺影像报告和数据系统（BI-RADS）分类］接受VABB手术的病人临床病理资料。登记内容包括收治例数、超声分级及术后病理结果，研究者运用SPSS 26.0软件对数据进行汇总分析，并采用Z检验比较妇幼保健医院与综合性医院的病理分布差异。结果    共纳入49 984例病人，其中BI-RADSⅢ类结节27 461例，术后病理提示恶性肿瘤321例（1.2%）、良性肿瘤伴非典型增生1 211例（4.4%）、未见肿瘤成分1 231例（4.5%）；BI-RADSⅣ类结节22 523例，术后病理提示恶性肿瘤1 460例（6.5%）、良性肿瘤伴非典型增生1 814例（8.1%）、未见肿瘤成分1 277例（5.7%）。不同医院类型比较显示，妇幼保健医院Ⅲ类结节恶性率2.5%，综合性医院0.9%，差异有统计学意义（P＜0.05）；在Ⅳ类结节中，各病理类型占比亦均差异无统计学意义（P＜0.05）。结论    基于超声BI-RADSⅢ-Ⅳ类乳腺结节采用VABB技术切除，是实现乳腺癌早期诊断及病理学规范管理的重要手段。该技术在三级医院及基层医疗机构均具推广潜力，建议进一步加强超声分级的标准化培训和术后病理流程优化，以提升诊断准确性和临床治疗效果。

关键词: 真空辅助旋切手术（VABB）, 超声引导乳腺病灶活检, BI-RADSⅢ-Ⅳ类乳腺结节, 病理分布, 非典型增生, 恶性肿瘤检出率, 医院类型比较, 规范化临床应用

Abstract: To investigate the current clinical application of vacuum-assisted breast biopsy(VABB) in China, and to evaluate the postoperative pathological distribution of lesions across different breast imaging reporting and data system (BI-RADS) categories as well as diagnostic differences among hospital types, thereby providing a basis for standardized implementation and early diagnosis. Methods    A questionnaire survey was conducted to collect clinical and pathological data of patients with BI-RADS category Ⅲ-Ⅳ breast nodules who underwent VABB at 39 Chinese hospitals between January 1, 2023 and December 31, 2023. Recorded data included the number of cases, BI-RADS classification, and postoperative pathological findings. Data were analyzed using SPSS version 26.0, and Z-tests were performed to compare pathological distribution differences between maternal and child healthcare hospitals and general hospitals. Results    A total of 49 984 patients were included, among whom BI-RADS Ⅲ nodules accounted for 27 461 cases, with postoperative pathology indicating malignancy in 321 cases (1.2%), benign tumors with atypical hyperplasia in 1 211 cases (4.4%), and absence of tumor components in 1 231 cases (4.5%), whereas BI-RADS Ⅳ nodules accounted for 22 523 cases, with malignancy in 1 460 cases (6.5%), benign tumors with atypical hyperplasia in 1 814 cases (8.1%), and absence of tumor components in 1 277 cases (5.7%). Comparison by hospital type showed that the malignancy rate for BI-RADS Ⅲ nodules was 2.5% in maternal and child healthcare hospitals versus 0.9% in general hospitals, with a statistically significant difference (P<0.05), and for BI-RADS Ⅳ nodules, the proportions of all pathological categories also differed significantly (P<0.05). Conclusion    VABB of BI-RADS Ⅲ-Ⅳ breast nodules is an important approach for early breast cancer diagnosis and standardized pathological management. This technique has promotion potential in both tertiary and primary-level institutions. It is recommended to strengthen standardized training in ultrasound grading and optimize postoperative pathological workflows to improve diagnostic accuracy and clinical outcomes.

Key words: vacuum-assisted breast biopsy (VABB), ultrasound-guided breast lesion biopsy, BI-RADS Ⅲ-Ⅳ breast nodules, pathological distribution, atypical hyperplasia, malignancy detection rate, hospital type comparison, standardized clinical application