Gentile Lori F, Himmler Amber, Shaw Christiana M, Bouton Amber, Vorhis Elizabeth, Marshall Julia, Spiguel Lisa R P
Department of Surgery, University of Florida, Gainesville, Florida, USA.
Department of Radiology, University of Florida, Gainesville, Florida, USA.
Ann Surg Oncol. 2016 Oct;23(10):3284-9. doi: 10.1245/s10434-016-5325-x. Epub 2016 Jun 23.
Wire localization is currently the most widely used localization strategy for excision of nonpalpable breast lesions. Its disadvantages include patient discomfort, wire-related complications such as wire displacement/fracture, and operating room delays related to difficulties during wire placement. We have implemented the technique of intraoperative ultrasound-guided excision using hydrogel-encapsulated (HydroMARK) biopsy clips for lesion localization. We hypothesize that this method is as effective as wire localization for breast conserving therapy.
This is a retrospective review of 220 consecutive patients who underwent segmental mastectomy or excisional biopsy using wire localization or hydrogel-encapsulated clip localization from January 2014 to July 2015. Data were collected and analyzed. Statistical analyses for differences between groups were performed using t tests and Mann-Whitney rank-sum analyses.
A total of 107 excisions were performed using hydrogel-encapsulated clip localization, and 113 excisions were performed using the traditional wire localization technique; 68 % of our patients underwent excision for malignant pathology. Wire placement took a mean of 46 minutes (range 20-180 min), compared with 5 minutes for ultrasound localization (p < .001). Successful intraoperative ultrasound localization and excision was performed on 100 % of patients. There was no difference in re-excision rates for positive margins or overall specimen size between the two groups.
Intraoperative ultrasound-guided excision of nonpalpable breast lesions using a hydrogel-encapsulated biopsy clip for breast conserving therapy is a safe and feasible alternative to the traditional preoperative wire localized excision. This technique will lead to improvement in patient experience, operative efficiency, and alleviate wire-related complications.
目前，金属丝定位是切除不可触及乳腺病变最广泛使用的定位策略。其缺点包括患者不适、与金属丝相关的并发症，如金属丝移位/断裂，以及与金属丝放置困难相关的手术室延迟。我们采用了术中超声引导下切除技术，使用水凝胶包裹（HydroMARK）活检夹进行病变定位。我们假设这种方法在保乳治疗中与金属丝定位一样有效。
这是一项对220例连续患者的回顾性研究，这些患者在2014年1月至2015年7月期间接受了使用金属丝定位或水凝胶包裹夹定位的节段性乳房切除术或切除活检。收集并分析数据。使用t检验和曼-惠特尼秩和分析对组间差异进行统计分析。
共使用水凝胶包裹夹定位进行了107例切除，使用传统金属丝定位技术进行了113例切除；68%的患者因恶性病变接受切除。金属丝放置平均需要46分钟（范围20 - 180分钟），而超声定位平均需要5分钟（p <.001）。100%的患者成功进行了术中超声定位和切除。两组在切缘阳性的再次切除率或总体标本大小方面没有差异。
术中超声引导下使用水凝胶包裹活检夹切除不可触及乳腺病变进行保乳治疗是传统术前金属丝定位切除的一种安全可行的替代方法。该技术将改善患者体验、提高手术效率并减轻与金属丝相关的并发症。
