Kaufman Cary S, Jacobson Leslie, Bachman Barbara, Kaufman Lauren
University of Washington, Bellingham Breast Center, Bellingham, Washington, USA.
Ann Surg Oncol. 2002 Dec;9(10):988-93. doi: 10.1007/BF02574517.
Mammogram-directed wire localization for nonpalpable cancer requires surgeon's time and coordination and some patient discomfort. Up to half of these nonpalpable lesions can be visualized by ultrasound. Use of intraoperative ultrasound streamlines the process of image-guided surgery.
We prospectively visualized 69 nonpalpable breast cancers between January 1998 and July 2001. Ultrasound localization was performed in the operating room immediately before definitive surgery. Breast cancers were localized using either blue dye or a guide wire.
Ultrasound correctly localized all lesions at surgery. Negative margins for invasive carcinoma were found in 97% (67 of 69) of patients. Re-excisions were performed in only 6% (4 of 69) of patients. Overall negative margins were found in 90% (62 of 69) of patients. Most positive margins (71%) were due to the presence of noncalcified ductal carcinoma in situ. Mastectomy was necessary in 4% of patients, usually due to multifocal invasive carcinoma.
Increased familiarity with ultrasound has allowed the surgeon to localize breast cancer in the operating room, improving the process of image-guided surgery. Ultrasound localization is accurate, time efficient, technically feasible, and easier for the patient. The re-excision rate is very low and is similar to that for mammographic localization. Intraoperative ultrasound localization should be considered whenever a breast cancer needs image-guided excision.
对于不可触及的乳腺癌，乳腺钼靶引导下的金属丝定位需要外科医生花费时间并进行协调，且会给患者带来一定不适。高达一半的此类不可触及病变可通过超声显示。术中超声的应用简化了图像引导手术的过程。
我们前瞻性地对1998年1月至2001年7月期间的69例不可触及的乳腺癌进行了超声定位。在确定性手术前立即在手术室进行超声定位。使用蓝色染料或导丝对乳腺癌进行定位。
超声在手术中正确定位了所有病变。97%（69例中的67例）的患者浸润性癌切缘阴性。仅6%（69例中的4例）的患者进行了再次切除。90%（69例中的62例）的患者总体切缘阴性。大多数阳性切缘（71%）是由于存在非钙化性导管原位癌。4%的患者需要进行乳房切除术，通常是由于多灶性浸润性癌。
对外科医生而言，对超声的熟悉程度增加使其能够在手术室中对乳腺癌进行定位，从而改善了图像引导手术的过程。超声定位准确、省时、技术上可行，且对患者来说更简便。再次切除率非常低，与乳腺钼靶定位相似。每当需要对乳腺癌进行图像引导切除时，都应考虑术中超声定位。
