Charpin C, Bonnier P, Habib M C, Andrac L, Vacheret H, Lavaut M N, Ansaldi J L, Allasia C, Piana L
Pathology Department, Hôpital de la Timone, Marseille, France.
Anticancer Res. 1992 Sep-Oct;12(5):1737-46.
Surgical specimens, from 78 patients operated for impalpable breast lesions containing microcalcifications detected on mammographs (breast cancer screening program) were systematically examined by a pathologist during the surgical intervention. The per-operative procedures encompassed (i) X-raying of the unfixed specimens to ascertain that the latter did enclose the screened lesion, (ii) slicing and subsequent X-raying of the specimens slices in order to locate the microcalcifications, (iii) histological evaluation of areas containing the microcalcifications on frozen sections. Thirty-two of the lesions were histologically benign, 55% were malignant and 13% borderline. Forty of the carcinomas were in situ and 60% were invasive. The per-operative histological diagnosis was correct in 65% of the case, erroneous in 10% and uncertain in 25%. Malignancy was never overscored. In 65% of the carcinomas diagnosed during the surgical intervention, the in sano margins excision and axillary lymph node removal could be performed (one stage surgical treatment). These results suggest that X-raying of sliced specimens and histological evaluation during the surgical intervention ascertains that lesions screened by mammographs are effectively and completely removed, and that they are precisely and extensively histologically examined after being identified and located.
对78例因乳腺钼靶检查（乳腺癌筛查项目）发现微钙化但触诊不可及的乳腺病变而接受手术的患者的手术标本，病理学家在手术过程中进行了系统检查。术中操作包括：（i）对未固定标本进行X线检查，以确定标本确实包含筛查出的病变；（ii）对标本切片进行切片及后续X线检查，以定位微钙化；（iii）对冰冻切片上含有微钙化的区域进行组织学评估。其中32例病变组织学为良性，55%为恶性，13%为交界性。40例癌为原位癌，60%为浸润性癌。术中组织学诊断65%正确，10%错误，25%不确定。恶性程度从未被高估。在手术中诊断出的癌中，65%可以进行肿瘤切除边缘无瘤及腋窝淋巴结清扫（一期手术治疗）。这些结果表明，术中对切片标本进行X线检查和组织学评估可确保钼靶筛查出的病变得到有效、彻底切除，并在识别和定位后进行精确、广泛的组织学检查。
