Ciccarelli G, Di Virgilio M R, Menna S, Garretti L, Ala A, Giani R, Bussone R, Canavese G, Berardengo E
C. Radiologia Diagnostica 7, Presidio Ospedaliero San Giovanni Antica Sede, A.S.O. San Giovanni Battista di Torino, Via Cavour 31, I-10123 Turin, Italy.
Radiol Med. 2007 Apr;112(3):366-76. doi: 10.1007/s11547-007-0147-3. Epub 2007 Apr 20.
The purpose of this study was to evaluate the diagnostic reliability of specimen radiography in the assessment of the status of resection margins in early stage breast lesions.
The study involved 123 consecutive patients who underwent breast-conserving surgery for early stage breast lesions. Specimen radiography in the two orthogonal views and with direct magnification was obtained in all cases to assess presence or absence of the lesion, position of the lesion within the surgical specimen and direction in which to extend the excision in cases of lesions located close to the margin. Diagnostic reliability was evaluated for only 102 patients with malignant lesions.
Comparison between the radiological and histological diagnoses before immediate reexcision had 66% sensitivity, 86% specificity, 74% positive predictive value and 81% negative predictive value. Definitive histological assessment of margin status, including status after reexcision, was infiltrated margins in 23 patients (23%) and clear margins in 79 patients (77%). Definitive histological assessment in 12/19 patients (63.15%) with intraoperative reexcision, confirmed margin infiltration of the first specimen. Twenty patients (20%) underwent a second surgical procedure.
Specimen radiography was reliable in identifying clear margins (74% positive predictive value) and reduced the rate of reintervention from 31% to 20%. Better results will be provided by digital mammographic equipment.
本研究旨在评估标本射线照相术在评估早期乳腺病变切除边缘状态中的诊断可靠性。
本研究纳入了123例连续接受早期乳腺病变保乳手术的患者。所有病例均获取了两个正交视图且带有直接放大功能的标本射线照相，以评估病变的有无、病变在手术标本中的位置以及病变靠近边缘时切除范围的延伸方向。仅对102例恶性病变患者评估了诊断可靠性。
在即刻再次切除前，放射学诊断与组织学诊断之间的比较显示，灵敏度为66%，特异度为86%，阳性预测值为74%，阴性预测值为81%。对边缘状态的最终组织学评估，包括再次切除后的状态，23例患者（23%）为浸润性边缘，79例患者（77%）为切缘阴性。在19例术中再次切除的患者中，12例（63.15%）的最终组织学评估证实了第一个标本的边缘浸润。20例患者（20%）接受了第二次手术。
标本射线照相术在识别切缘阴性方面可靠（阳性预测值为74%），并将再次干预率从31%降至20%。数字乳腺摄影设备将提供更好的结果。
