保乳手术切缘评估及术中乳腺X线摄片的临床应用

摘要/Abstract

中图分类号:

R737.9

Andriani（李美珠）, 吴佳毅(综述), 朱丽(审校). 保乳手术切缘评估及术中乳腺X线摄片的临床应用[J]. 外科理论与实践, 2020, 25(06): 537-540.

Andriani Lisa, WU Jiayi, ZHU Li. Clinical application of intraoperative specimen mammography in evalution of margin during breast conserving surgery[J]. Journal of Surgery Concepts & Practice, 2020, 25(06): 537-540.

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术中乳腺X线摄片在保乳手术临床应用的相关研究

文献	出版年	术中乳腺X线摄片组(n)	无术中乳腺X线摄片组(n)	临床病理特征	结果
Bathla等^{[ 18 ]}	2011	102	/	①均为术前未触及病灶;②79.4% 为浸润性导管癌;③肿瘤直径平均1.6 cm	①73例（71.6%）术中乳腺X线摄片评估切除范围足够,其中17例（23.2%）术后病理结果为切缘阳性;余29例（28.4%）术中乳腺X线摄片评估切除范围不足,予以补充切除,其中2例（6.9%）石蜡病理切缘阳性;②19例（18.6%）切缘阳性中,其中15例（14.7%）需行再次保乳手术;③术中乳腺X线摄片使84.3%病人首次手术中成功完成保乳手术
Layfield等^{[ 23 ]}	2012	104	107	①均为术前触及病灶;②84.5%为浸润性导管癌	①术中乳腺X线摄片显著降低切除标本的大小（110.2 g比70.3 g,P=0.001）;②术中乳腺X线摄片对于降低切缘阳性率及再切除率差异无统计学意义（29.8%比24.2%,P=0.60;23.4%比27.4%,P=0.65）
Kim等^{[ 19 ]}	2013	96	105	①均为术前未触及病灶;②63%为浸润性导管癌;③69%肿块直径≤2 cm ;④51%乳腺X线检查表现为钙化	①术中乳腺X线摄片更好地降低切缘阳性（12.7%比26.6%,P=0.012）及近切缘阳性率（25.3%比37.2%,P=0.028）;②再切除率两组差异无统计学意义（14.6%比17.1%,P=0.641）
Ihrai等^{[ 20 ]}	2014	155	/	①77例为术前未触及病灶;②74.7%为浸润性导管癌	①16例术中乳腺X线摄片后行补充切缘切除,其中10例（6.5%）石蜡病理检查切缘阳性;②术中乳腺X线摄片降低3.8% 切缘阳性率
Majdak- Paredes等^{[ 21 ]}	2015	98	/	①70%为术前未触及病灶;②72.4%为浸润性导管癌	仅3例（3%）切缘阳性
Hisada等^{[ 22 ]}	2016	174	/	①24%为术前未触及肿块;②70%为浸润性导管癌;③56%肿块直径≤2 cm;④仅29%病人乳腺X线表现为钙化	①24例（13.8%）术中乳腺X线摄片评估后行再切除;②150例（86.2%）未再切除;③切缘阳性率在两组病例中相似（20.8%比20.0%)

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参考文献23

[1]	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424. doi:10.3322/caac.21492 URL
[2]	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2):115-132. doi:10.3322/caac.21338 URL
[3]	Habermann EB, Abbott A, Parsons HM, et al. Are mastectomy rates really increasing in the United States?[J]. J Clin Oncol, 2010, 28(21):3437-3441. doi:10.1200/JCO.2009.27.6774 URL
[4]	Garcia-Etienne CA, Mariano T, Joerg H, et al. Mastectomy trends for early-stage breast cancer: A report from the EUSOMA multi-institutional European database[J]. Eur J Cancer, 2012, 48(13):1947-1956. doi:10.1016/j.ejca.2012.03.008pmid:22483323
[5]	Huang NS, Liu MY, Chen JJ, et al. Surgical management of breast cancer in China: A 15-year single-center retrospective study of 18.502 patients[J]. Medicine, 2016, 95(45):e4201. doi:10.1097/MD.0000000000004201 URL
[6]	Johns N, Dixon JM. Should patients with early breast cancer still be offered the choice of breast conserving surgery or mastectomy?[J]. Eur J Surg Oncol, 2016, 42(11):1636-1641. doi:S0748-7983(16)30861-7pmid:27665053
[7]	Lovrics PJ, Cornacchi SD, Farrokhyar F, et al. The relationship between surgical factors and margin status after breast-conservation surgery for early stage breast cancer[J]. Am J Surg, 2009, 197(6):740-746. doi:10.1016/j.amjsurg.2008.03.007pmid:18789424
[8]	邵志敏. 乳腺腺癌保乳手术的进展与评述[J]. 肿瘤防治研究, 2018, 45(5):269-273.
[9]	Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for Radiation Oncology Consensus Guideline on margins for breast-conserving surgery with whole-breast irradiation in stages Ⅰ and Ⅱ invasive breast cancer[J]. Ann Surg Oncol, 2014, 21(3):704-716. doi:10.1245/s10434-014-3481-4 URL
[10]	Houssami N, Macaskill P, Marinovich ML, et al. Meta-analysis of the impact of surgical margins on local reccurence in women with early-stage invasive breast cancer treated with breast-conserving therapy[J]. Eur J Cancer, 2010, 46(18):3219-3232. doi:10.1016/j.ejca.2010.07.043pmid:20817513
[11]	Marinovich ML, Azizi L, Macaskill P, et al. The association of surgical margins and local recurrence in women with ductal carcinoma in situ treated with breast-conser-ving therapy: a meta-analysis[J]. Ann Surg Oncol, 2016, 23:3811-3821. pmid:27527715
[12]	Pilewskie M, Morrow M. Margins in breast cancer: how much is enough?[J]. Cancer, 2018, 124(7):1335-1341. doi:10.1002/cncr.31221pmid:29338088
[13]	Morrow M, Van Zee KJ, Solin LJ, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline in margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ[J]. Ann Surg Oncol, 2016, 23(12):3801-3810. doi:10.1245/s10434-016-5449-z URL
[14]	Fisher B, Wolmark N, Fisher ER, et al. Lumpectomy and axillary dissection for breast cancer: surgical, pathological, and radiation considerations[J]. World J Surg, 1985, 9(5):692-698. pmid:4060746
[15]	Smith BL, Gadd MA, Lanahan CR, et al. Real-time, intraoperative detection of residual breast cancer in lumpectomy cavity walls using a novel cathepsin-activa-ted fluorescent imaging system[J]. Breast Cancer Res Treat, 2018, 171:413-420. doi:10.1007/s10549-018-4845-4 URL
[16]	Smith BL, Lanahan CR, Specht MC, et al. Feasibility study of a novel protease-activated fluorescent imaging system for real-time, intraoperative detection of residual breast cancer in breast conserving surgery[J]. Ann Surg Oncol, 2020, 27(6):1854-1861. doi:10.1245/s10434-019-08158-1 URL
[17]	Kho E, Boer LL, Vijver KKV, et al. Hyperspectral ima-ging for resection margin assessment during cancer surgery[J]. Clin Cancer Res, 2019, 25:3572-3580. doi:10.1158/1078-0432.CCR-18-2089 URL
[18]	Bathla L, Harris A, Davey M, et al. High resolution intra-operative two-dimensional specimen mammography and its impact on second operation for re-excision of positive margins at final pathology after breast conservation surgery[J]. Am J Surg, 2011, 202(4):387-394. doi:10.1016/j.amjsurg.2010.09.031 URL
[19]	Kim SH, Cornacchi SD, Heller B, et al. An evaluation of intraoperative digital specimen mammography versus conventional specimen radiography for the excision of nonpalpable breast lesion[J]. Am J Surg, 2013, 205(6):703-710. doi:10.1016/j.amjsurg.2012.08.010 URL
[20]	Ihrai T, Quaranta D, Fouche Y, et al. Intraoperative radiological margin assessment in breast-conserving surgery[J]. Eur J Surg Oncol, 2014, 40(4):449-453. doi:10.1016/j.ejso.2014.01.002pmid:24468296
[21]	Majdak-Paredes EJ, Schaverien MV, Szychta P, et al. Intra-operative digital specimen radiology reduces re-ope-ration rates in therapeutic mammaplasty for breast cancer[J]. The Breast, 2015, 24(5):556-559. doi:10.1016/j.breast.2015.04.007 URL
[22]	Hisada T, Sawaki M, Ishiguro J, et al. Impact of intrao-perative specimen mammography on margins in breast-conserving surgery[J]. Mol Clin Oncol, 2016, 5(3):269-272. doi:10.3892/mco.2016.948 URL
[23]	Layfield DM, May DJ, Cutress RI, et al. The effect of introducing an in-theatre intra-operative specimen radiography (IOSR) system on the management of palpable breast cancer within a single unit[J]. The breast, 2012, 21(4):459-463. doi:10.1016/j.breast.2011.10.010 URL

保乳手术切缘评估及术中乳腺X线摄片的临床应用

Clinical application of intraoperative specimen mammography in evalution of margin during breast conserving surgery

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