Uematsu Takayoshi, Sano Muneaki, Homma Keiichi, Sato Nobuaki
Division of Diagnostic Radiology, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Breast J. 2004 Jan-Feb;10(1):33-7. doi: 10.1111/j.1524-4741.2004.10102.x.
The authors reviewed Niigata Cancer Center Hospital's experience treating patients with lumpectomy to evaluate the utility of three-dimensional helical computed tomography (3D-CT) image-guided made-to-order lumpectomy and determine a positive margin rate. From April 1993 to September 2000, 251 breasts in 248 patients were treated with lumpectomy with a 1 cm macroscopic free margin. In 213 breasts (85%), 3D-CT image-guided made-to-order lumpectomy was performed. Thirty-eight breasts (15%) underwent a lumpectomy without 3D-CT. The lumpectomy specimen was sectioned at 5 mm intervals. Margin status was classified as negative (no invasive or ductal carcinoma in situ (DCIS) within 2 mm from the cut surface) or positive. Positive margins were classified as focally positive (invasive or DCIS transected at the margin within 5 mm or one slide) or massively positive. With 3D-CT image-guided lumpectomy, 21% (45/213) of lesions had a positive margin and 42% (16/38) of lesions without 3D-CT image-guided lumpectomy had a positive margin (p = 0.0055). For lesions with massively positive margins, the rates were 9% (4/45) for 3D-CT image-guided lumpectomy and 38% (6/16) for lumpectomy without 3D-CT (p = 0.0152). 3D-CT image-guided made-to-order lumpectomy decreased the positive surgical margin rate. Among patients with positive margins, those with 3D-CT image-guided lumpectomy have less residual cancer than those without 3D-CT.
作者回顾了新潟癌症中心医院对行肿块切除术患者的治疗经验，以评估三维螺旋计算机断层扫描（3D-CT）图像引导下定制肿块切除术的效用，并确定切缘阳性率。1993年4月至2000年9月，248例患者的251个乳房接受了切缘为1 cm宏观无瘤边缘的肿块切除术。213个乳房（85%）进行了3D-CT图像引导下的定制肿块切除术。38个乳房（15%）未进行3D-CT引导下的肿块切除术。肿块切除标本以5 mm间隔切片。切缘状态分为阴性（距切面2 mm内无浸润性癌或原位导管癌（DCIS））或阳性。阳性切缘分为局灶性阳性（切缘处5 mm内或一张切片上有浸润性癌或DCIS）或广泛性阳性。在3D-CT图像引导下的肿块切除术中，21%（45/213）的病变切缘阳性，而在未进行3D-CT图像引导下肿块切除术的病变中，42%（16/38）切缘阳性（p = 0.0055）。对于广泛性阳性切缘的病变，3D-CT图像引导下肿块切除术的比例为9%（4/45），未进行3D-CT引导下肿块切除术的比例为38%（6/16）（p = 0.0152）。3D-CT图像引导下的定制肿块切除术降低了手术切缘阳性率。在切缘阳性的患者中，接受3D-CT图像引导下肿块切除术的患者残留癌比未接受3D-CT引导的患者少。
