Hollow-core needle aspiration biopsy is a technique that uses a hollow-core, fully automated biopsy needle to extract material from a precise lesion under image guidance. This technique has the advantages of minimal injury and precise sampling, allowing pathological examination to determine the benignity and malignancy of the lesion and then determine the treatment plan. In most cases, hollow-core needle aspiration can obtain enough specimens for histopathological diagnosis, and it can distinguish between invasive and in situ cancer, so it has been used as a routine means to identify breast lumps in foreign countries for many years.
The necessity of hollow-core needle aspiration biopsy: breast diseases are complex and diverse, and auxiliary examinations such as ultrasound and mammography can only make a preliminary assessment of the lesion, while pathological results are the gold standard for judging the benignity and malignancy of the lesion. Hollow-core needle puncture sampling for thin strips of focal tissue, under the microscope can clearly determine the benignity and malignancy of the lesion, according to the nature of the lesion patients can discuss with the doctor the next treatment options (such as surgery, neoadjuvant chemotherapy, etc.).
II. Puncture steps.
1. The patient is placed in a supine or lateral position, exposing the puncture site so that the site to be punctured is located at a high point.
2, Routine disinfection of laying towel, local anesthesia with 2% lidocaine at the proposed puncture site.
3.Supervision: the biopsy gun is wound by pressing the 1 and 2 suprasternal keys sequentially.
4, into the needle: first break the skin (small blade, skin needle), and then puncture under the guidance of the image. Pay attention to the skin texture into the needle, rotate the handle to enter more easily. When holding it horizontally, you can rotate it so that the front striking trigger side is up.
5.Unsafety: Press the safety button to the right to release the safety.
6, firing: use the Freehand method under ultrasound guidance, always keep the puncture needle in the plane of the acoustic beam, when the tip of the tissue biopsy needle is observed to reach the edge of the lesion, press the front or back firing trigger to excite the biopsy gun, pay attention to keep the handle in place to avoid jumping backwards to affect sampling.
7, sampling: quickly withdraw the needle, while compressing the wound for hemostasis. Press the draw 1 winding key, exit the needle core of the biopsy needle, observe the quality of the sample in the sampling slot, if the tissue strip is taken satisfactorily, wipe the tissue strip on the filter paper sheet.
8, repeat the above operation to obtain 3 to 6 satisfactory tissue strips, the specimen strips containing calcification and the specimen strips without calcification were divided into different containers, fixed with 4% formaldehyde and sent for examination.
9. After puncture, press the puncture site with fingers for 5-30 minutes, and leave with no obvious abnormal bleeding on ultrasound review.
III. Intraoperative complications.
1, bleeding, pain, infection
2, needle tract transfer implantation may: relatively rare. However, after a lot of clinical research and practice, it has been shown that hollow core needle puncture biopsy will not lead to tumor dissemination.
3, pneumothorax: rare. Complications can be controlled by controlling the needle path and reducing the number of punctures. Therefore, under the operation of experienced physicians, hollow-core needle aspiration biopsy is not terrible and patients can choose it with confidence.
Precautions.
1.Select the incision and use the principle of proximity.
2.Take film or video to record the location of the lesion and the puncture needle under image localization.
3.Calculate the angle of needle entry and ejection distance to avoid puncture injury to organs, nerves and large blood vessels. Especially when the breast is thin or the lesion is located in the deep side of the gland, the angle of needle should be made more parallel to the chest wall and the ejection distance should be calculated to avoid puncture injury to the posterior glandular structures and lungs.
4. Take sufficient material to ensure pathological diagnosis. Conditional centers should place metal markers on the biopsy site.
IV. Postoperative management.
1, postoperative pressure bandage should be applied for at least 24 h. If ecchymosis or hematoma appears, the bandage can be extended for 1~2 d. Generally, ecchymosis or hematoma can subside after 2~4 weeks.
2. Biopsy specimens of microcalcifications should be immediately mammographed to confirm whether the lesion is taken.