Fysh Thomas, Boddy Alex, Godden Amy
Department of Breast Surgery, South Devon Healthcare Trust, Lowes Bridge, Torquay TQ2 7AA, UK.
Int J Breast Cancer. 2013;2013:854234. doi: 10.1155/2013/854234. Epub 2013 May 23.
Aim. When excision margins are close or involved following breast conserving surgery, many surgeons will attempt to reexcise the corresponding cavity margin. Margins are ascribed to breast specimens such that six faces are identifiable to the pathologist, a process that may be prone to error at several stages. Methods. An experimental model was designed according to stated criteria in order to answer the research question. Computer software was used to measure the surface areas of experimental surfaces to compare human-painted surfaces with experimental controls. Results. The variability of the hand-painted surfaces was considerable. Thirty percent of hand-painted surfaces were 20% larger or smaller than controls. The mean area of the last surface painted was significantly larger than controls (mean 58996 pixels versus 50096 pixels, CI 1477-16324, P = 0.014). By chance, each of the six volunteers chose to paint the deep surface last. Conclusion. This study is the first to attempt to quantify the extent of human error in marking imaginary boundaries on a breast excision model and suggests that humans do not make these judgements well, raising questions about the safety of targeting single margins at reexcision.
目的。在保乳手术后切缘接近或受累时，许多外科医生会尝试再次切除相应的腔隙切缘。乳腺标本的切缘是确定的，这样病理学家可以识别六个面，这一过程在几个阶段可能容易出错。方法。根据既定标准设计了一个实验模型，以回答研究问题。使用计算机软件测量实验表面的表面积，将人工绘制的表面与实验对照进行比较。结果。人工绘制表面的变异性相当大。30%的人工绘制表面比对照大20%或小20%。最后绘制的表面的平均面积显著大于对照（平均58996像素对50096像素，可信区间1477 - 16324，P = 0.014）。偶然的是，六名志愿者都选择最后绘制深部表面。结论。本研究首次尝试量化在乳腺切除模型上标记虚拟边界时人为误差的程度，并表明人类在做出这些判断方面表现不佳，这对再次切除时针对单一切缘的安全性提出了疑问。
