Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
PLoS One. 2013 Sep 20;8(9):e74028. doi: 10.1371/journal.pone.0074028. eCollection 2013.
Margin status is one of the most important predictors of local recurrence after breast conserving surgery (BCS). Intraoperative ultrasound guidance (IOUS) has the potential to improve surgical accuracy for breast cancer. The purpose of the present meta-analysis was to determine the efficacy of IOUS in breast cancer surgery and to compare the margin status to that of the more traditional Guide wire localization (GWL) or palpation-guidance.
We searched the database of PubMed for prospective and retrospective studies about the impact of IOUS on margin status of breast cancer, and a meta-analysis was conducted.
Of the 13 studies included, 8 were eligible for the impact of IOUS on margin status of non-palpable breast cancers, 4 were eligible for palpable breast cancers, and 1 was for both non-palpable and palpable breast cancers. The rate of negative margins of breast cancers in IOUS group was significantly higher than that in control group without IOUS (risk ratio (RR) = 1.37, 95% confidence interval (CI) = 1.18-1.59 from 7 prospective studies, odds ratio (OR) = 2.75, 95% CI = 1.66-4.55 from 4 retrospective studies). For non-palpable breast cancers, IOUS-guidance enabled a significantly higher rate of negative margins than that of GWL-guidance (RR = 1.26, 95% CI = 1.09-1.46 from 6 prospective studies; OR = 1.45, 95% CI = 0.86-2.43 from 2 retrospective studies). For palpable breast cancers, relative to control group without IOUS, the RR for IOUS associated negative margins was 2.36 (95% CI = 1.26-4.43) from 2 prospective studies, the OR was 2.71 (95% CI = 1.25-5.87) from 2 retrospective studies.
This study strongly suggests that IOUS is an accurate method for localization of non-palpable and palpable breast cancers. It is an efficient method of obtaining high proportion of negative margins and optimum resection volumes in patients undergoing BCS.
切缘状态是保乳手术后局部复发的最重要预测因素之一。术中超声引导（IOUS）有可能提高乳腺癌手术的准确性。本荟萃分析的目的是确定 IOUS 在乳腺癌手术中的疗效，并比较其与传统导丝定位（GWL）或触诊引导的切缘状态。
我们在 PubMed 数据库中搜索了关于 IOUS 对乳腺癌切缘状态影响的前瞻性和回顾性研究，并进行了荟萃分析。
在纳入的 13 项研究中，有 8 项研究符合 IOUS 对不可触及乳腺癌切缘状态影响的纳入标准，4 项研究符合可触及乳腺癌的纳入标准，1 项研究符合不可触及和可触及乳腺癌的纳入标准。IOUS 组乳腺癌阴性切缘率明显高于无 IOUS 的对照组（来自 7 项前瞻性研究的风险比（RR）=1.37，95%置信区间（CI）=1.18-1.59；来自 4 项回顾性研究的比值比（OR）=2.75，95%CI=1.66-4.55）。对于不可触及的乳腺癌，IOUS 引导显著提高了阴性切缘率，优于 GWL 引导（来自 6 项前瞻性研究的 RR=1.26，95%CI=1.09-1.46；来自 2 项回顾性研究的 OR=1.45，95%CI=0.86-2.43）。对于可触及的乳腺癌，与无 IOUS 的对照组相比，IOUS 相关的阴性切缘率 RR 为 2.36（95%CI=1.26-4.43），来自 2 项前瞻性研究；OR 为 2.71（95%CI=1.25-5.87），来自 2 项回顾性研究。
本研究强烈表明 IOUS 是一种准确的定位不可触及和可触及乳腺癌的方法。它是一种在接受保乳手术的患者中获得高比例阴性切缘和最佳切除量的有效方法。
