Department of Surgery, Breast Surgery Unit, Salamanca University Hospital, Paseo S. Vicente 82, 37007 Salamanca, Spain.
Department of Radiology, Breast Unit, Salamanca University Hospital, Salamanca, Spain.
Int J Surg. 2014;12(6):572-7. doi: 10.1016/j.ijsu.2014.04.003. Epub 2014 Apr 13.
A complete clinical response after neoadjuvant chemotherapy (NACT) in breast cancer patients hinders the localization of the residual lesion and the removal of a minimum amount of breast tissue. The aim of the present work is to report our single-centre experience with intraoperative ultrasound-guided (IOUS) excision performed by surgeons in these patients.
From January 2008 to December 2012, IOUS excisions were performed on 58 patients with a previous intralesional ultrasound-detectable metallic marker and non-palpable breast cancer after NACT. The specimen margins were estimated by ultrasonography and macroscopic pathologic examination. Successful lesion removal, specimen weight, and analysis of the results as regards margins were evaluated, and the need for breast-conserving re-excision and mastectomy was considered.
After NACT the average ultrasound/mammography and MRI diameters were 11.7 mm (0-30) and 9.1 mm (0-40) respectively. In all cases, the residual lesion or tissue around the marker was removed. The average weight of the specimens was 26.4 g (6-84), being lower in cases of complete response according to ultrasound (p < 0.05). In 4 patients (6.8%), breast-conserving re-excision was carried out, and in 3 patients (5.2%) a secondary mastectomy was performed, two of which had invasive lobular carcinoma.
The emplacement of a readily echodetectable metal marker before NACT makes IOUS excision feasible in an increasing number of complete clinical responses, with the excision of small amounts of breast tissue and a high percentage of conservative breast surgery. This technique requires surgeons to be trained, but has the advantage of a reduced use of other hospital services, better planning of operating theatres, and less discomfort for patients, which means that it is attractive and indeed recommendable.
新辅助化疗（NACT）后乳腺癌患者完全临床缓解会阻碍残留病变的定位和最小量乳房组织的切除。本研究旨在报道我们单中心使用术中超声引导（IOUS）技术在这些患者中行切除术的经验。
自 2008 年 1 月至 2012 年 12 月，对 58 例 NACT 后瘤内超声可检测到金属标记且不可触及的乳腺癌患者进行 IOUS 切除术。通过超声和大体病理检查评估标本边缘。评估了成功切除病变、标本重量以及对边缘结果的分析，并考虑了保乳再次切除和乳房切除术的必要性。
NACT 后，平均超声/乳房 X 线摄影和 MRI 直径分别为 11.7mm（0-30）和 9.1mm（0-40）。在所有病例中，均切除了残留病变或标记周围的组织。标本平均重量为 26.4g（6-84），根据超声检查，完全缓解病例的标本重量较低（p<0.05）。4 例（6.8%）患者进行了保乳再次切除，3 例（5.2%）患者进行了二次乳房切除术，其中 2 例为浸润性小叶癌。
在 NACT 前放置易于超声检测的金属标记，使得 IOUS 切除在越来越多的完全临床缓解病例中成为可能，可切除少量的乳房组织，并进行高比例的保乳手术。该技术需要对外科医生进行培训，但具有减少其他医院服务使用、更好地规划手术室以及减轻患者不适的优势，因此具有吸引力且值得推荐。
