Sharek Danielle, Zuley Margarita L, Zhang Janie Yue, Soran Atilla, Ahrendt Gretchen M, Ganott Marie A
1 Radiologic Consultants, Ltd, Greensburg, PA.
AJR Am J Roentgenol. 2015 Apr;204(4):872-7. doi: 10.2214/AJR.14.12743.
The purpose of this study was to compare outcomes of radioactive seed localization (RSL) versus wire localization using surgical margin size, reexcision and reoperation rates, specimen size, radiology resource utilization, and cosmesis as measures.
Patients who underwent RSL before segmental mastectomy from April 1, 2011, to March 1, 2012, for biopsy-proven cancer were selected. Each was matched using tumor size, type, and surgeon to a wire localization control case, resulting in 232 cases. Width of the closest surgical margin, reexcision rate, and reoperation rate were compared as were the ratios of tumor volume to initial surgical specimen volume and tumor volume to all surgically excised volume (including reexcisions and reoperations). Cosmetic outcome was analyzed by comparison of Harvard scores and specimen volume with breast volume. Radiology resource utilization was compared before and after RSL implementation.
No significant differences between methods were found in closest surgical margin (RSL mean, 0.45 cm; wire localization mean, 0.45 cm; p=0.972), reexcision rate (RSL mean, 21.1%; wire localization mean, 26.3%; p=0.360), reoperation rate (RSL, 11.4%; wire localization, 12.7%; p=0.841), ratio of the tumor volume to initial surgical specimen volume (RSL mean, 0.027; wire localization mean, 0.028; p=0.886), ratio of the tumor volume to total volume resected (RSL mean, 0.024; wire localization mean, 0.024; p=0.997), or in clinical or computed cosmesis scores (clinical p=0.5; calculated p=0.060). There was a 34% increase in scheduled biopsy slot utilization, 50% savings in time spent scheduling, and a 4.1-day average decrease in biopsy wait time after RSL institution.
RSL is an acceptable alternative to wire localization and offers significant improvements in workflow.
本研究旨在以手术切缘大小、再次切除率和再次手术率、标本大小、放射学资源利用情况及美容效果作为衡量指标，比较放射性种子定位（RSL）与金属丝定位的效果。
选取2011年4月1日至2012年3月1日期间在节段性乳房切除术前接受RSL且活检证实为癌症的患者。根据肿瘤大小、类型和外科医生，将每例患者与金属丝定位对照病例进行匹配，共得到232例病例。比较最接近手术切缘的宽度、再次切除率和再次手术率，以及肿瘤体积与初始手术标本体积的比值和肿瘤体积与所有手术切除体积（包括再次切除和再次手术）的比值。通过比较哈佛评分和标本体积与乳房体积来分析美容效果。比较实施RSL前后的放射学资源利用情况。
两种方法在最接近手术切缘（RSL平均值为0.45厘米；金属丝定位平均值为0.45厘米；p = 0.972）、再次切除率（RSL平均值为21.1%；金属丝定位平均值为26.3%；p = 0.360）、再次手术率（RSL为11.4%；金属丝定位为12.7%；p = 0.841）、肿瘤体积与初始手术标本体积的比值（RSL平均值为0.027；金属丝定位平均值为0.028；p = 0.886）、肿瘤体积与总切除体积的比值（RSL平均值为0.024；金属丝定位平均值为0.024；p = 0.997）或临床或计算机美容评分（临床p = 0.5；计算得出p = 0.060）方面均未发现显著差异。实施RSL后，预定活检时段的利用率提高了34%，安排时间节省了50%，活检等待时间平均缩短了4.1天。
RSL是金属丝定位的可接受替代方法，并且在工作流程方面有显著改进。
