Romanoff Anya, Schmidt Hank, McMurray Matthew, Burnett Annika, Condren Audree, Port Elisa
Department of Surgery, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Surgery, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York.
J Surg Res. 2017 Apr;210:177-180. doi: 10.1016/j.jss.2016.11.008. Epub 2016 Nov 11.
Nonpalpable breast lesions require localization before excision. This is most commonly performed with a wire (WL) or a radioactive seed (SL), which is placed into the breast under radiographic guidance. Although there are advantages of each modality, there are no guidelines to address which patients should undergo WL versus SL. We investigated factors influencing the selection of SL versus WL at our institution and assessed patient satisfaction with each procedure.
Patients undergoing preoperative localization of nonpalpable breast lesions from May 2014 through August 2015 were included. Physicians were surveyed on surgical scheduling to evaluate factors influencing the decision to perform SL or WL. Patient satisfaction was evaluated with a survey at the first postoperative visit. Retrospective chart review was performed.
341 patients were included: 104 (30%) patients underwent SL and 237 (70%) underwent WL. There was no difference in patient age, benign versus malignant disease, or need for concomitant axillary surgery comparing the SL versus WL groups. Physician survey indicated that 18% of patients were candidates for WL only. Of the patients who were eligible for both, 88 (41%) ultimately underwent SL and 126 (59%) had WL. The most commonly cited reason for selection of one localization method or the other was physician preference, followed by patient preference or avoiding additional visit. There was no significant difference in self-reported preoperative anxiety level, convenience of the localization procedure, pain of the localization procedure, operative experience, postoperative pain level or medication requirement, or overall patient satisfaction comparing patients who underwent SL and WL.
SL and WL offer patients similar comfort and satisfaction. Factors influencing selection of one modality over the other include both logistic and clinical considerations.
不可触及的乳腺病变在切除前需要进行定位。最常用的方法是在影像学引导下将导丝（WL）或放射性种子（SL）置入乳腺。虽然每种方法都有其优点，但目前尚无指南指导哪些患者应接受WL或SL。我们调查了在我们机构影响SL与WL选择的因素，并评估了患者对每种方法的满意度。
纳入2014年5月至2015年8月期间接受不可触及乳腺病变术前定位的患者。就手术安排对医生进行调查，以评估影响进行SL或WL决策的因素。在术后首次就诊时通过问卷调查评估患者满意度。进行回顾性病历审查。
共纳入341例患者：104例（30%）患者接受了SL，237例（70%）接受了WL。SL组和WL组在患者年龄、良性与恶性疾病或是否需要同期腋窝手术方面无差异。医生调查表明，18%的患者仅适合WL。在两种方法都适用的患者中，88例（41%）最终接受了SL，126例（59%）接受了WL。选择一种定位方法而非另一种的最常见原因是医生的偏好，其次是患者的偏好或避免额外就诊。在自我报告的术前焦虑水平、定位程序的便利性、定位程序的疼痛、手术体验、术后疼痛水平或药物需求以及总体患者满意度方面，接受SL和WL的患者之间没有显著差异。
SL和WL给患者带来的舒适度和满意度相似。影响选择一种方法而非另一种方法 的因素包括后勤和临床方面的考虑。
