Istituto di Radiologia Universitaria, Azienda Ospedaliero Universitaria di Udine, Ple S Maria della Misericordia, 33100 Udine, Italy.
Breast. 2010 Dec;19(6):532-7. doi: 10.1016/j.breast.2010.06.001. Epub 2010 Jul 6.
To evaluate the accuracy of surgical specimen ultrasound in the assessment of the status of resection margins after breast-conserving surgery.
Sonographic examination of 46 surgical specimens of US-detectable malignant tumors was performed. Distance of the lesion from the specimen margins in four radial directions was measured and compared with distances measured on pathologic examination. Positive pathologic margins were defined when invasive or intraductal carcinoma was found within 2 mm of the specimen margin. Sensitivity, specificity, positive(PPV) and negative predictive values(NPV) of US in predicting surgical margins were calculated, considering both a 10-mm and a 4-mm sonographic threshold.
Of 184 margins(4 per lesion), pathology demonstrated 28 positive and 156 negative margins. Considering the 10-mm cut-off, US identified 32 positive and 152 negative margins, showing the following sensitivity, specificity, PPV and NPV: 28.5%, 84.6%, 25% and 86.8%, respectively. Considering the 4-mm cut-off, US identified 7 positive and 177 negative margins, with a sensitivity of 7.1%, a specificity of 96.8%, a PPV of 28.2% and a NPV of 85.3%. False-negative results were more frequent in case of invasive lobular carcinoma (20%) and presence of intraductal component (60%).
Sonography demonstrated a poor performance in the evaluation of the status of resection margins in breast specimens; however, because of the high NPV -both with 10-mm and 4-mm thresholds- it might be helpful in confirming complete excision of a US-detected neoplasm and in ruling out the presence of macroscopic invasive ductal carcinoma at surgical margins.
评估超声在评估保乳手术后切缘状态中的准确性。
对 46 例超声可检测恶性肿瘤的手术标本进行了超声检查。在四个径向方向上测量病变距标本边缘的距离，并与病理检查测量的距离进行比较。当在标本边缘 2mm 内发现浸润性或导管内癌时，将阳性病理切缘定义为阳性。考虑到 10mm 和 4mm 的超声阈值，计算了超声预测手术切缘的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
在 184 个边缘（每个病变 4 个）中，病理显示 28 个阳性边缘和 156 个阴性边缘。考虑到 10mm 的截止值，超声识别出 32 个阳性和 152 个阴性边缘，其敏感性、特异性、PPV 和 NPV 分别为 28.5%、84.6%、25%和 86.8%。考虑到 4mm 的截止值，超声识别出 7 个阳性和 177 个阴性边缘，敏感性为 7.1%，特异性为 96.8%，PPV 为 28.2%，NPV 为 85.3%。浸润性小叶癌（20%）和存在导管内成分（60%）时，假阴性结果更为常见。
超声在评估乳腺标本切缘状态方面表现不佳；然而，由于高阴性预测值-无论是 10mm 还是 4mm 的阈值-它可能有助于证实超声检测到的肿瘤已完全切除，并排除手术切缘存在宏观浸润性导管癌。
