Krekel Nicole M A, Haloua Max H, Muller Sandra, Bergers Elisabeth, Rietveld Derek H F, Meijers Sybren, van den Tol M Petrousjka
VU medisch centrum, Afd. Chirurgische Oncologie, Amsterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2012;156(29):A3573.
To conduct qualitative research into breast-conserving surgery for palpable and non-palpable breast tumours and the various methods of excising these, measured by the volume exised and surgical radicality.
Retrospective, multicentre study.
The pathology reports from 726 patients who had undergone breast-conserving surgery for invasive breast cancer were reviewed for excision volume and radicality. Any excess resected breast tissue was expressed by a Calculated Resection Ratio (CRR) and calculated by dividing the volume of the surgical specimen by the tumour volume plus an ideal 1-cm-margin of tumour-free breast tissue. A CRR of 1.0 meant that the volume excised was ideal; a CRR of 2.0 meant that twice the necessary amount of tissue had been removed.
Of all the 726 tumours, 72% appeared to be palpable. The median CRR in this group was 2.2 (range: 0.1 - 43.0) and the percentage of tumour-involved margins (irradicality) was 22.5%. Of all the non-palpable tumour (n = 201) excisions, 58% had been guided by wire-localisation, 26% by ultrasonography, and 16% by ROLL (Radio-guided Occult Lesion Localization). The CRRs were 2.8, 3.2 and 3.8, respectively (p < 0.05). Ultrasound-guided surgery resulted in the lowest rate of tumour-involved margins (ultrasound-guided: 3.8%, wire-guided localisation: 21.4%, ROLL: 25.0% (p = 0.05)).
Breast-conserving surgery is associated with an average of a 2 to 4-fold removal of excessive tissue. Nevertheless, 1 out of 5 excisions are not radical. Ultrasound-guided surgery for non-palpable breast cancer is the most effective method for achieving radical excision. A multicentre, prospective, randomised trial has been started to assess whether ultrasound-guided lumpectomy for palpable breast cancer can lead to optimisation of the excision volume and radicality.
对可触及和不可触及乳腺肿瘤的保乳手术及其各种切除方法进行定性研究，以切除体积和手术根治性作为衡量指标。
回顾性多中心研究。
对726例行浸润性乳腺癌保乳手术患者的病理报告进行回顾，分析切除体积和根治性。切除的多余乳腺组织用计算切除率（CRR）表示，计算方法为手术标本体积除以肿瘤体积加上理想的1厘米无瘤乳腺组织边缘。CRR为1.0表示切除体积理想；CRR为2.0表示切除的组织量是所需量的两倍。
在所有726个肿瘤中，72%似乎是可触及的。该组的CRR中位数为2.2（范围：0.1 - 43.0），肿瘤切缘受累（根治性不足）的百分比为22.5%。在所有不可触及肿瘤（n = 201）切除术中，58%采用钢丝定位引导，26%采用超声引导，16%采用ROLL（放射性引导隐匿病变定位）。CRR分别为2.8、3.2和3.8（p < 0.05）。超声引导手术导致肿瘤切缘受累率最低（超声引导：3.8%，钢丝定位引导：21.4%，ROLL：25.0%（p = 0.05））。
保乳手术平均会切除2至4倍的多余组织。然而，五分之一的切除术并不彻底。超声引导下的不可触及乳腺癌手术是实现根治性切除的最有效方法。一项多中心、前瞻性、随机试验已启动，以评估超声引导下的可触及乳腺癌肿块切除术是否能优化切除体积和根治性。
