Layeequr Rahman Rakhshanda, Crawford Sybil, Larkin Anne, Quinlan Robert
UMass Memorial Health Care, Worcester, Massachussetts, USA.
Ann Surg Oncol. 2007 Aug;14(8):2228-32. doi: 10.1245/s10434-007-9422-8. Epub 2007 May 19.
The goal of breast conservation in cancer treatment is to obtain adequate margins with minimum tissue loss to achieve acceptable oncologic and cosmetic outcome. The standard for resection of breast cancers visible only on mammogram is wire localization (WL), which has a high rate of positive margins. We hypothesized that sonographic hematoma guided (SHG) resection achieves better margin clearance while minimizing volume of resection by more accurate lesion localization.
This retrospective study was conducted at the University Comprehensive Breast Center. Consecutive patients over the span of one year, undergoing breast conservation for stereotactic biopsy proven cancers that were not visualized on ultrasound were studied. SHG and WL technique were compared for age, mammographic abnormality, and tumor characteristics. Outcome variables included closest margin of resection, volume of resection, resection index (resection volume/tumor volume), and rate of margin revision.
Forty-five patients had SHG, while 51 had WL lumpectomy. The SHG and WL groups were similar in age, mammographic abnormality, tumor type, and stage. Median (25th-75th centile) tumor size was larger in SHG group vs WL group [1.2 (1.1-1.3) vs 0.8 (0.4-1.4) cm; P = .009]. Median (25th-75th centile) closest margin in SHG vs WL group was 5.0 (5.0-8.0) vs 4.0 (1.0-10) mm [P = .0041]. Median (25th-75th centile) resection volume in SHG vs WL group was 85.0 (60.0-128.0) vs 142.2 (54.4-229.0) cm(3) [P = .0127]. Median (25th-75th centile) resection index in SHG vs WL group was 77.3 (59.3-285.7) vs 337.1 (88.9-3982.2) [P = .0004]. Margin was revised in 2 (4.4%) SHG vs 8 (15.7%) WL patients [P = .0978].
Sonographic hematoma guided lumpectomy is superior to wire localization in obtaining adequate margins with minimal volume of resection.
癌症治疗中保乳的目标是在最小化组织损失的情况下获得足够的切缘，以实现可接受的肿瘤学和美容效果。仅在乳腺钼靶上可见的乳腺癌切除标准是金属丝定位（WL），其切缘阳性率较高。我们假设超声血肿引导（SHG）切除通过更准确的病变定位能在最小化切除体积的同时实现更好的切缘清除。
这项回顾性研究在大学综合乳腺中心进行。研究了连续一年中因立体定向活检证实为癌症且在超声上不可见而接受保乳治疗的患者。比较了SHG和WL技术在年龄、乳腺钼靶异常和肿瘤特征方面的情况。结果变量包括最接近的切除切缘、切除体积、切除指数（切除体积/肿瘤体积）和切缘修正率。
45例患者接受了SHG，51例接受了WL乳房肿块切除术。SHG组和WL组在年龄、乳腺钼靶异常、肿瘤类型和分期方面相似。SHG组的中位（第25-75百分位数）肿瘤大小大于WL组[1.2（1.1-1.3）cm对0.8（0.4-1.4）cm；P = 0.009]。SHG组与WL组最接近的中位（第25-75百分位数）切缘分别为5.0（5.0-8.0）mm和4.0（1.0-10）mm[P = 0.0041]。SHG组与WL组的中位（第25-75百分位数）切除体积分别为85.0（60.0-128.0）cm³和142.2（54.4-229.0）cm³[P = 0.0127]。SHG组与WL组的中位（第25-75百分位数）切除指数分别为77.3（59.3-285.7）和337.1（88.9-3982.2）[P = 0.0004]。SHG组2例（4.4%）与WL组8例（15.7%）患者的切缘进行了修正[P = 0.0978]。
超声血肿引导乳房肿块切除术在获得足够切缘且切除体积最小方面优于金属丝定位。
