Milligan Robert, Pieri Andrew, Critchley Adam, Peace Richard, Lennard Tom, O'Donoghue J M, Howitt Rachel, Nicholson Stewart, Cain Henry, Petrides George, Sibal Nidhi
1 Department of Cellular Pathology,Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Upon Tyne , UK.
2 Department of Breast Surgery,Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Upon Tyne , UK.
Br J Radiol. 2018 Jan;91(1081):20170268. doi: 10.1259/bjr.20170268. Epub 2017 Nov 16.
In the UK, guidewires have traditionally been used for localization of non-palpable breast lesions in patients undergoing breast conservation surgery (BCS). Radioactive seed localization (RSL) using Iodine-125 seeds is an alternative localization method and involves inserting a titanium capsule, containing radioactive Iodine-125, into the breast lesion. We aim to demonstrate feasibility of RSL compared with guidewire-localization (GWL) for BCS in the UK.
Data were collected on 100 patients with non-palpable unifocal invasive carcinoma of the breast undergoing GWL WLE prior to the introduction of RSL and the first 100 patients treated with RSL WLE. Statistical comparisons were made using Χ-squared analysis or unpaired two-sample t-test. Significance was determined to be at p ≤ 0.05.
Mean total tumour size was 19.44 mm (range: 5-55) in the GWL group and 18.61 mm (range: 3.8-59) in the RSL group (p = 0.548), while mean total specimen excision weight was significantly lower in the RSL group; 31.55 g (range: 4.5-112) vs 37.42 g (range: 7.8-157.1) (p = 0.018). Although 15 patients had inadequate surgical resection margins in the GWL group compared the 13 in the RSL group (15 vs 13%, respectively, p = 0.684), 10 of the patients in the GWL group had invasive carcinoma present resulting in at least one positive margin compared with only 3 patients in the RSL group (10 vs 3%, respectively, p = 0.045).
In this study, RSL is shown to be non-inferior to the use of GWL for non-palpable carcinoma in patients undergoing BCS and we suggest that it could be introduced successfully in other breast units. Advances in knowledge: Here we have demonstrated the use of RSL localization results in significant lower weight resection specimens of breast carcinoma when compared with a matched group using GWL, without any significant differences in oncological outcome between the groups.
在英国，传统上导丝用于保乳手术（BCS）患者中不可触及乳腺病变的定位。使用碘 - 125种子的放射性种子定位（RSL）是一种替代定位方法，包括将含有放射性碘 - 125的钛胶囊插入乳腺病变中。我们旨在证明在英国RSL与导丝定位（GWL）用于BCS的可行性。
收集了100例在引入RSL之前接受GWL全乳切除（WLE）的不可触及的单灶性乳腺浸润癌患者以及首批100例接受RSL WLE治疗患者的数据。使用卡方分析或非配对双样本t检验进行统计学比较。显著性判定为p≤0.05。
GWL组的平均肿瘤总大小为19.44毫米（范围：5 - 55），RSL组为18.61毫米（范围：3.8 - 59）（p = 0.548），而RSL组的平均总标本切除重量显著更低；31.55克（范围：4.5 - 112）对37.42克（范围：7.8 - 157.1）（p = 0.018）。虽然GWL组有15例患者手术切缘不足，而RSL组有13例（分别为15%对13%，p = 0.684），但GWL组有10例患者存在浸润癌导致至少一个切缘阳性，而RSL组只有3例患者（分别为10%对3%，p = 0.045）。
在本研究中，RSL被证明在接受BCS的患者中对于不可触及的癌并不劣于使用GWL，并且我们建议它可以在其他乳腺科室成功引入。知识进展：在此我们证明，与使用GWL的匹配组相比，RSL定位导致乳腺癌切除标本重量显著降低，且两组间肿瘤学结果无任何显著差异。
