Department of Surgery, Mayo Clinic, Phoenix, AZ, USA.
UCSD Department of Surgery, UCSD Cancer Center, Encinitas, USA.
Ann Surg Oncol. 2018 Jan;25(1):18-27. doi: 10.1245/s10434-016-5756-4. Epub 2017 Jan 5.
Breast surgeons have a wide variety of intraoperative techniques available to help achieve low rates for positive margins of excision, with variable levels of evidence.
A systematic review of the medical literature from 1995 to July 2016 was conducted, with 434 abstracts identified and evaluated. The analysis included 106 papers focused on intraoperative management of breast cancer margins and contained actionable data.
Ultrasound-guided lumpectomy for palpable tumors, as an alternative to palpation guidance, can lower positive margin rates, but the effect when used as an alternative to wire localization (WL) for nonpalpable tumors is less certain. Localization techniques such as radioactive seed localization and radioguided occult lesion localization were found potentially to lower positive margin rates as alternatives to WL depending on baseline positive margin rates. Intraoperative pathologic methods including gross histology, frozen section analysis, and imprint cytology all have the potential to lower the rates of positive margins. Cavity-shave margins and the Marginprobe device both lower rates of positive margins, with some potential for negative cosmetic effects. Specimen radiography and multiple miscellaneous techniques did not affect positive margin rates or provided too little evidence for formation of a conclusion.
A systematic review of the literature showed evidence that several intraoperative techniques and actions can lower the rates of positive margins. These results are presented together with graded recommendations.
乳腺外科医生有多种术中技术可用于帮助降低切缘阳性率，但其证据水平不一。
对 1995 年至 2016 年 7 月的医学文献进行系统回顾，共确定并评估了 434 篇摘要。分析包括 106 篇专注于乳腺癌切缘术中管理的论文，其中包含可操作数据。
超声引导下的触诊肿瘤切除术作为触诊引导的替代方法，可以降低阳性切缘率，但对于不可触诊肿瘤，作为 WL 替代方法的效果尚不确定。定位技术，如放射性种子定位和放射性导向隐匿性病变定位，可作为 WL 的替代方法，降低阳性切缘率，具体取决于基线阳性切缘率。术中病理方法，包括大体组织学、冷冻切片分析和印片细胞学，都有降低阳性切缘率的潜力。腔面切除术和 Marginprobe 装置都降低了阳性切缘率，但可能对美容效果产生负面影响。标本放射摄影和多种其他技术没有影响阳性切缘率或提供的证据太少，无法得出结论。
对文献的系统回顾表明，有几种术中技术和操作可以降低阳性切缘率。这些结果与分级推荐一起呈现。
