Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands.
Eur J Surg Oncol. 2012 Dec;38(12):1218-24. doi: 10.1016/j.ejso.2012.07.107. Epub 2012 Aug 5.
An important benefit of neoadjuvant chemotherapy, as compared to adjuvant chemotherapy, in breast cancer patients is down staging of the primary tumour, which allows for more breast-conserving surgery. When a tumour becomes non-palpable after this down staging, precise localisation of the original tumour bed is crucial to be able to perform breast-conserving surgery. Radioguided Occult Lesion Localisation with (99m)Technetium (ROLL-(99m)Tc) is commonly used to perform breast-conserving surgery in patients with non-palpable breast tumours. We modified this technique to use it in the neoadjuvant setting. The present analysis was performed to assess its feasibility and analyse the number of patients in which a mastectomy was correctly withheld using this technique.
A retrospective analysis was performed for all patients who were treated with neoadjuvant chemotherapy between 2007 and 2010 in our institute and underwent breast-conserving surgery with the ROLL-(99m)Tc technique afterwards. The status of the margins and the weight of the resected specimen were assessed.
The median weight of the resected specimen in these 83 patients was 53 g (range: 11-204 g). Eleven of the 58 patients with residual disease revealed positive margins at pathological examination. However, in only 5 of those 11 patients a secondary mastectomy was indicated. This means that in 94% of all included patients a mastectomy was correctly withheld.
The ROLL-(99m)Tc technique is a feasible technique that can be used to perform breast-conserving surgery after neoadjuvant chemotherapy in a carefully selected group of patients.
与辅助化疗相比，新辅助化疗对乳腺癌患者的一个重要益处是肿瘤降期，这使得更多的患者可以接受保乳手术。当肿瘤经过降期后变得不可触及时，精确地定位原始肿瘤床对于能够进行保乳手术至关重要。放射性核素引导的隐匿性病变定位（99mTc）（ROLL-（99m）Tc）通常用于在不可触及的乳腺肿瘤患者中进行保乳手术。我们对该技术进行了改进，以便在新辅助环境中使用。本分析旨在评估其可行性，并分析使用该技术正确避免行乳房切除术的患者数量。
对我院 2007 年至 2010 年间接受新辅助化疗并随后接受 ROLL-（99m）Tc 技术保乳手术的所有患者进行回顾性分析。评估了切缘的状态和切除标本的重量。
在这 83 例患者中，切除标本的中位数重量为 53g（范围：11-204g）。在 58 例有残留疾病的患者中有 11 例在病理检查时显示切缘阳性。然而，在这 11 例患者中只有 5 例需要进行二次乳房切除术。这意味着在所有纳入的患者中，94%的患者正确地避免了乳房切除术。
ROLL-（99m）Tc 技术是一种可行的技术，可在仔细选择的患者组中在新辅助化疗后进行保乳手术。
