Al-Hilli Zahraa, Glazebrook Katrina N, McLaughlin Sarah A, Chan Danielle M, Robinson Kyle T, Giesbrandt Jamie G, Slomka Evelyn L, Pizzitola Victor J, Gray Richard J, Jakub James W
Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2015 Oct;22(10):3350-5. doi: 10.1245/s10434-015-4749-z. Epub 2015 Jul 29.
Radioactive seed localization has been shown to be a reliable and safe alternative to wire localization in breast surgery, but little is known about the use of multiple localization seeds. This study evaluated the utilization of multiple seeds in the same breast.
All patients who underwent localization of breast lesions using multiple I-125 seeds at three Mayo Clinic sites between January 2003 and June 2014 were included.
A total of 461 operations were performed during an 11.5-year study period. The indications for multiple seed placement in the same breast included multiple lesions (n = 258), bracketing (n = 110), multiple lesions and bracketing (n = 67), and a second inserted for more precise localization (n = 26). Among patients with bracketing seeds, the mean distance between seeds was 45 (range 8-110) mm. Removal of the targeted lesion was successful in all cases; 96% of bracketed lesions were removed as a single specimen, and a 98% retrieval rate within the first specimen was obtained. In total 108 of 382 (28%) patients had close or positive margin resulting in a second procedure and 60 of 177 (34%) patients with bracketing procedures underwent reexcision of positive margins or culminated in a mastectomy. Routine intraoperative frozen section analysis was associated with a lower reoperation rate compared with a selective approach to intraoperative margin assessment.
The use of multiple radioactive seeds for localizing multiple lesions in the same breast or bracketing lesions is feasible and safe. Because of the extent of disease, a substantial percentage of these patients require margin reexcision or conversion to mastectomy.
放射性粒子定位已被证明是乳腺手术中线定位的一种可靠且安全的替代方法，但对于多个定位粒子的使用知之甚少。本研究评估了在同一乳房中使用多个粒子的情况。
纳入2003年1月至2014年6月期间在梅奥诊所三个地点使用多个I-125粒子对乳腺病变进行定位的所有患者。
在11.5年的研究期间共进行了461例手术。在同一乳房中放置多个粒子的指征包括多个病变（n = 258）、括弧定位（n = 110）、多个病变及括弧定位（n = 67）以及为更精确的定位而第二次插入粒子（n = 26）。在进行括弧定位粒子的患者中，粒子之间的平均距离为45（范围8 - 110）mm。所有病例中目标病变的切除均成功；96%的括弧定位病变作为单个标本被切除，并且在第一个标本中的取出率达到98%。382例患者中有108例（28%）切缘接近或阳性，导致进行第二次手术，177例进行括弧定位手术的患者中有60例（34%）因切缘阳性接受再次切除或最终接受乳房切除术。与术中切缘评估的选择性方法相比，常规术中冰冻切片分析与较低的再次手术率相关。
在同一乳房中使用多个放射性粒子定位多个病变或括弧定位病变是可行且安全的。由于疾病范围，这些患者中有相当比例需要切缘再次切除或转为乳房切除术。
