Department of Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
Ann Surg Oncol. 2011 Feb;18(2):447-52. doi: 10.1245/s10434-010-1280-0. Epub 2010 Aug 24.
Few published studies have shown the benefits of intraoperative ultrasound in avoiding inadequate margins in breast-conserving surgery. The aim of this study is to quantify intraoperative ultrasound margin size and assess its relationship to tumor size, multifocality, palpability, histology, and presence of intraductal component.
Patients with breast cancer undergoing breast-conserving surgery in whom the operating surgeon visualized the tumor by ultrasound were included. Ultrasound margins measured intraoperatively were prospectively recorded and compared with pathology margins.
Forty-five patients with 48 tumors were included. Twenty five patients (56%) had palpable tumors. Pathologic mean tumor size was 1.9 cm [95% confidence interval (CI) 1.6-2.2 cm, range 0.5-4.8 cm]. There was good correlation between closest margins recorded by ultrasound and pathology margins (r = 0.4674, P < 0.0008). Fourteen patients (31%) had margins re-excised intraoperatively, 12 of them in the direction of the closest pathological margin. Three patients (7%), all of whom had intraoperative re-excision, had a second operation for involved margins without residual cancer on pathological examination of the reoperative specimens. Ultrasound margins ≥0.5 cm achieved adequate pathology margins of ≥0.2 cm in 95% of margins. Overestimation of pathology margins by ultrasound measurement was significantly affected by multifocality (P = 0.0473). Tumor size, palpability, invasive lobular histology, and presence of ductal carcinoma in situ (DCIS) did not cause significant overestimation of pathology margins by ultrasound.
Intraoperative ultrasound may help maintain a low level of reoperation after breast-conserving surgery. Ultrasound margins <0.5 cm should be re-excised intraoperatively. Reliability of ultrasound in predicting the closest pathology margins was diminished in patients with multifocal tumors.
很少有发表的研究表明术中超声在避免保乳手术切缘不足方面的益处。本研究的目的是量化术中超声切缘的大小，并评估其与肿瘤大小、多灶性、可触知性、组织学和导管内成分的关系。
纳入接受保乳手术且术中超声能观察到肿瘤的乳腺癌患者。前瞻性记录术中测量的超声切缘，并与病理切缘进行比较。
共纳入 45 例 48 个肿瘤患者。25 例（56%）有可触及的肿瘤。病理平均肿瘤大小为 1.9 cm [95%置信区间（CI）1.6-2.2 cm，范围 0.5-4.8 cm]。术中记录的最接近切缘与病理切缘之间相关性较好（r = 0.4674，P < 0.0008）。14 例（31%）患者术中再次切除切缘，其中 12 例沿最接近的病理切缘方向切除。3 例（7%）患者因术中再次切除切缘有累及切缘，而再次手术，但在再次手术标本的病理检查中均未发现残留癌。95%的超声切缘≥0.5 cm 可获得≥0.2 cm 的病理切缘。超声测量对病理切缘的高估受多灶性的显著影响（P = 0.0473）。肿瘤大小、可触知性、浸润性小叶癌组织学和导管原位癌（DCIS）并不导致超声对病理切缘的显著高估。
术中超声可能有助于降低保乳手术后再次手术的水平。超声切缘<0.5 cm 应在术中再次切除。在多灶性肿瘤患者中，超声预测最接近的病理切缘的可靠性降低。
