Sumiyoshi Kazuhiro, Nohara Takehiro, Iwamoto Mitsuhiko, Tanaka Satoru, Kimura Kosei, Takahashi Yuko, Kurisu Yoshitaka, Tsuji Motomu, Tanigawa Nobuhiko
Departments of General and Breast and Endocrine Surgery, and.
Exp Ther Med. 2010 Jul;1(4):641-645. doi: 10.3892/etm_00000100. Epub 2010 Jul 1.
In breast-conserving surgery, positive margins are closely related to intramammary recurrence, but methods of assessing resection stumps during breast-conserving surgery have not been standardized. The present study investigated the usefulness of intraoperative touch smear cytology in our department. From 2005 to 2008, a total of 420 patients underwent breast cancer surgery. Subjects comprised 160 patients who underwent breast-conserving surgery and touch smear cytology. Results of the touch smear cytology were compared to those of the histological tissue analysis. Touch smear cytology displayed 70% sensitivity (14/20), 97.1% specificity (136/140) and a diagnostic accuracy of 93.8% (150/160). Six false-negative cases and 4 false-positive cases were identified. Of the 6 false-negatives, cancer cells were noted in the ductal component in 5 cases, and the degree of cancer cell atypia in the stump was low. Residual cancer cells were noted in the stump in 18 cases, and additional resection was performed in 16 cases. Cancer cells were identified histologically in the additionally resected tissue in 8 of these 16 cases (50%). The direction of positive cytology was towards the nipple in 16 cases, lateral tissue in 5 cases and contralateral nipple in 2 cases. A greater cancer cell volume, as assessed by touch smear cytology, tended to be associated with higher frequency of positive margins, as assessed by histological tissue analysis. Touch smear cytology is easy to perform, offering a very useful technique yielding comparable results to histological tissue analysis.
在保乳手术中，切缘阳性与乳腺内复发密切相关，但保乳手术中评估切除残端的方法尚未标准化。本研究调查了我院术中触摸涂片细胞学检查的实用性。2005年至2008年，共有420例患者接受了乳腺癌手术。研究对象包括160例行保乳手术并进行触摸涂片细胞学检查的患者。将触摸涂片细胞学检查结果与组织学组织分析结果进行比较。触摸涂片细胞学检查的敏感性为70%（14/20），特异性为97.1%（136/140），诊断准确性为93.8%（150/160）。共发现6例假阴性病例和4例假阳性病例。在6例假阴性病例中，5例在导管成分中发现癌细胞，残端癌细胞异型性程度较低。18例残端发现残留癌细胞，其中16例进行了再次切除。在这16例再次切除的组织中，8例（50%）经组织学检查发现癌细胞。细胞学阳性方向朝向乳头者16例，朝向外侧组织者5例，朝向对侧乳头者2例。通过触摸涂片细胞学检查评估，癌细胞体积越大，经组织学组织分析评估的切缘阳性频率往往越高。触摸涂片细胞学检查操作简便，是一种非常有用的技术，其结果与组织学组织分析相当。
