Rahusen Frans D, Bremers Andre J A, Fabry Hans F J, van Amerongen A H M Taets, Boom Rob P A, Meijer S
Department of Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands.
Ann Surg Oncol. 2002 Dec;9(10):994-8. doi: 10.1007/BF02574518.
The wire-guided excision of nonpalpable breast cancer often results in tumor resections with inadequate margins. This prospective, randomized trial was undertaken to investigate whether intraoperative ultrasound (US) guidance enables a better margin clearance than the wire-guided technique in the breast-conserving treatment of nonpalpable breast cancers.
Patients with a preoperative histological diagnosis of nonpalpable breast cancer that could be visualized both with US and mammography were included. Patients were randomized to undergo either a wire-guided or a US-guided excision. Adequate margins were defined as >or=1 mm.
Of 49 included patients, 23 were assigned to undergo wire-guided excision and 26 to undergo US-guided excision. One patient crossed over to US-guided excision after inadvertent wire displacement. Mean tumor diameter, specimen weight, and operating time were similar in both groups. The excision was adequate in 24 (89%) of 27 US-guided excisions and 12 (55%) of 22 wire-guide excisions (P =.007).
US-guided excision seems to be superior to wire-guided excision with respect to margin clearance of mammographically detected and US-visible nonpalpable breast cancers. Patients do not have to undergo the unpleasant wire placement before surgery.
不可触及性乳腺癌的金属丝引导切除常常导致肿瘤切除切缘不足。本前瞻性随机试验旨在研究在不可触及性乳腺癌的保乳治疗中，术中超声（US）引导是否比金属丝引导技术能实现更好的切缘清除。
纳入术前经组织学诊断为不可触及性乳腺癌且超声和乳腺X线摄影均能显示的患者。患者被随机分为接受金属丝引导切除或超声引导切除。切缘充足定义为≥1毫米。
49例纳入患者中，23例被分配接受金属丝引导切除，26例接受超声引导切除。1例患者因金属丝意外移位而转为超声引导切除。两组的平均肿瘤直径、标本重量和手术时间相似。27例超声引导切除中有24例（89%）切除充分，22例金属丝引导切除中有12例（55%）切除充分（P = 0.007）。
对于乳腺X线摄影检测到且超声可见的不可触及性乳腺癌，在切缘清除方面，超声引导切除似乎优于金属丝引导切除。患者无需在手术前经历令人不适的金属丝置入。
