Carmichael A R, Ninkovic G, Boparai R
Princess Royal Hospital, Lewes Road, Haywards Heath, UK.
Breast. 2004 Aug;13(4):325-8. doi: 10.1016/j.breast.2004.01.010.
The ultimate goal of breast conserving surgery (BCS) is to achieve survival and local control rates similar to those for mastectomy while providing improved cosmetic and functional results. The volume of breast tissue removed is the most significant determinant of the final cosmetic outcome of BCS. We hypothesised that intra-operative specimen radiograph (IOSR) during BCS may guide the surgeon to achieve clear radiographic and histological margins with minimum normal breast tissue excision, thus preserving cosmetic appearance. The aim of this study was to evaluate the effect of introducing the policy of IOSR on the weight of specimens of wide local excision of palpable invasive breast cancer. All consecutive patients who underwent therapeutic wide local excision for palpable invasive breast cancer from 01/01/02 to 31/03/03 were included in this study. A policy of IOSR was introduced in October 2002, thus all BCS done after 01/10/2002 underwent IOSR. The mean (S.D.) specimen weight for the no intra-operative specimen radiograph (NIOSR) group was 74 grams compared to 46 g in the IOSR group, (P = 0.0241, unpaired t-test with Welch's correction) and the mean tumour size for the NIOSR was 23(13)mm and for IOSR was 21(8)mm (P = ns, unpaired t-test with Welch's correction). A histologically clear circumferential margin rate in the IOSR group was 96% compared to 82% in the NIOSR group. Five patients in the IOSR group and 11 in NIOSR group had positive anterior or posterior margin. For these patients no further surgical excision was possible as BCS was performed from skin to pectoral fascia. Therefore a radiation boost was given to the site of excision. Only one patient in the IOSR group needed further breast surgery (mastectomy) for a positive inferior (toward nipple) margin for a mammographically occult tumour, while 11 patients in the NIOSR group required further breast surgery. In conclusion, IOSR is a simple, effective and economical way of assessing adequacy of margins while minimising the breast tissue excised during wide local excision of palpable breast cancers.
保乳手术（BCS）的最终目标是在实现与乳房切除术相似的生存率和局部控制率的同时，改善美容效果和功能。切除的乳腺组织量是保乳手术最终美容效果的最重要决定因素。我们假设保乳手术期间的术中标本射线照片（IOSR）可以指导外科医生以最少的正常乳腺组织切除实现清晰的射线照相和组织学切缘，从而保留外观。本研究的目的是评估引入IOSR策略对可触及浸润性乳腺癌广泛局部切除标本重量的影响。2002年1月1日至2003年3月31日期间所有接受可触及浸润性乳腺癌治疗性广泛局部切除的连续患者均纳入本研究。2002年10月引入了IOSR策略，因此2002年10月1日之后进行的所有保乳手术均采用了IOSR。术中无标本射线照片（NIOSR）组的标本平均（标准差）重量为74克，而IOSR组为46克，（P = 0.0241，采用韦尔奇校正的不成对t检验），NIOSR组的平均肿瘤大小为23（13）mm，IOSR组为21（8）mm（P =无统计学意义，采用韦尔奇校正的不成对t检验）。IOSR组的组织学切缘清晰率为96%，而NIOSR组为82%。IOSR组有5例患者，NIOSR组有11例患者的前后切缘为阳性。对于这些患者，由于保乳手术是从皮肤到胸肌筋膜进行的，无法进行进一步的手术切除。因此，对切除部位进行了放射增敏。IOSR组只有1例患者因乳腺X线隐匿性肿瘤的下切缘（朝向乳头）阳性需要进一步的乳房手术（乳房切除术），而NIOSR组有11例患者需要进一步的乳房手术。总之，IOSR是一种简单、有效且经济的评估切缘充分性的方法，同时可将可触及乳腺癌广泛局部切除期间切除的乳腺组织降至最低。
