Service d'Urologie, Centre hospitalier universitaire vaudois, Lausanne, Switzerland.
J Urol. 2011 Dec;186(6):2188-93. doi: 10.1016/j.juro.2011.07.100. Epub 2011 Oct 19.
Surgery remains the treatment of choice for localized renal neoplasms. While radical nephrectomy was long considered the gold standard, partial nephrectomy has equivalent oncological results for small tumors. The role of negative surgical margins continues to be debated. Intraoperative frozen section analysis is expensive and time-consuming. We assessed the feasibility of intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy and its correlation with margin status on definitive pathological evaluation.
A study was done at 2 institutions from February 2008 to March 2011. Patients undergoing partial nephrectomy for T1-T2 renal tumors were included in analysis. Partial nephrectomy was done by a standardized minimal healthy tissue margin technique. After resection the specimen was kept in saline and tumor margin status was immediately determined by ex vivo ultrasound. Sequential images were obtained to evaluate the whole tumor pseudocapsule. Results were compared with margin status on definitive pathological evaluation.
A total of 19 men and 14 women with a mean ± SD age of 62 ± 11 years were included in analysis. Intraoperative ex vivo ultrasound revealed negative surgical margins in 30 cases and positive margins in 2 while it could not be done in 1. Final pathological results revealed negative margins in all except 1 case. Ultrasound sensitivity and specificity were 100% and 97%, respectively. Median ultrasound duration was 1 minute. Mean tumor and margin size was 3.6 ± 2.2 cm and 1.5 ± 0.7 mm, respectively.
Intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy is feasible and efficient. Large sample studies are needed to confirm its promising accuracy to determine margin status.
手术仍然是局部肾肿瘤的首选治疗方法。虽然根治性肾切除术长期以来被认为是金标准，但对于小肿瘤来说，部分肾切除术的肿瘤学结果是等效的。切缘阴性的作用仍存在争议。术中冰冻切片分析既昂贵又耗时。我们评估了在接受部分肾切除术的患者中对切缘进行术中离体超声检查的可行性，并评估了其与明确的病理评估时切缘状态的相关性。
该研究于 2008 年 2 月至 2011 年 3 月在 2 家机构进行。纳入接受 T1-T2 肾肿瘤部分肾切除术的患者进行分析。部分肾切除术采用标准化的最小健康组织切缘技术。切除后，标本保存在盐水中，并立即通过离体超声确定肿瘤切缘状态。获取连续图像以评估整个肿瘤假包膜。结果与明确的病理评估时的切缘状态进行比较。
共有 19 名男性和 14 名女性患者纳入分析，平均年龄 ± 标准差为 62 ± 11 岁。术中离体超声检查发现 30 例切缘阴性，2 例切缘阳性，1 例无法进行。最终病理结果除 1 例外均为阴性切缘。超声的敏感性和特异性分别为 100%和 97%。超声中位持续时间为 1 分钟。肿瘤和切缘的平均大小分别为 3.6 ± 2.2cm 和 1.5 ± 0.7mm。
在接受部分肾切除术的患者中，对切缘进行术中离体超声检查是可行且有效的。需要进一步的大样本研究来证实其确定切缘状态的有前途的准确性。
