Duarte G M, Cabello C, Torresan R Z, Alvarenga M, Telles G H Q, Bianchessi S T, Caserta N, Segala S R, de Lima M C L, Etchebehere E C S C, Camargo E E
Division of Oncology and Senology, Department of Obstetrics and Gynecology, School of Medicine, Universidade Estadual de Campinas, Campinas, Brazil.
Eur J Surg Oncol. 2007 Dec;33(10):1150-7. doi: 10.1016/j.ejso.2007.03.021. Epub 2007 May 10.
Women undergoing breast-conserving surgery for cancer can present residual disease. We have developed a technique called Radioguided Intraoperative Margins Evaluation (RIME) that uses a radiopharmaceutical to distinguish normal and cancer tissues. The aim of this study was to assess whether RIME is a feasible technique, and if it could help in breast cancer resection with free margins, minimizing residual disease.
Twenty-three breast cancer patients programmed for mastectomy were selected. Before surgery, the patients were submitted to scintimammography with 99mTc-sestamibi to estimate the optimal time to begin radioguided surgery. Twenty patients were submitted to magnetic resonance imaging (MRI), to evaluate skin, deep fascia and to detect other tumor foci. At the beginning of the surgery, the same dose of 99mTc-sestamibi was intravenously injected into patients. Tumor resection was performed under guidance of a gamma-probe, characterizing the RIME technique. Finally, modified radical mastectomy was performed. Tumor and residual breast were histopathologically examined.
The RIME technique was successfully performed in all patients. The principal tumor was removed by this technique and provided 82.6% of histologically free margins (mean margins, 4.8 mm). Additionally, 47.8% of patients were without residual disease. The mean size of residual carcinoma was 3.67 mm and generally located near the tumor bed (<1.5 cm). There was no significant association between presence of residual disease and tumor size or margin status.
RIME is a feasible technique that could help tumor resection with free margins; however, it seems to be limited for small carcinoma foci.
接受保乳手术治疗癌症的女性可能存在残留病灶。我们开发了一种称为放射性引导术中切缘评估（RIME）的技术，该技术使用放射性药物来区分正常组织和癌组织。本研究的目的是评估RIME是否是一种可行的技术，以及它是否有助于乳腺癌的无瘤切缘切除，最大限度地减少残留病灶。
选择23例计划行乳房切除术的乳腺癌患者。手术前，患者接受99mTc-司他莫比乳腺闪烁显像，以估计开始放射性引导手术的最佳时间。20例患者接受磁共振成像（MRI）检查，以评估皮肤、深筋膜并检测其他肿瘤病灶。手术开始时，向患者静脉注射相同剂量的99mTc-司他莫比。在γ探头引导下进行肿瘤切除，这是RIME技术的特点。最后，进行改良根治性乳房切除术。对肿瘤和残留乳腺进行组织病理学检查。
所有患者均成功实施了RIME技术。通过该技术切除了主要肿瘤，组织学无瘤切缘率为82.6%（平均切缘为4.8mm）。此外，47.8%的患者无残留病灶。残留癌的平均大小为3.67mm，通常位于肿瘤床附近（<1.5cm）。残留病灶的存在与肿瘤大小或切缘状态之间无显著关联。
RIME是一种可行的技术，有助于进行无瘤切缘的肿瘤切除；然而，它似乎对小癌灶有限制。
