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采用定制针引导切除的肿瘤整形保乳手术。

Oncoplastic breast conserving surgery with tailored needle-guided excision.

作者信息

Hernanz Fernando, González-Noriega Mónica, Sánchez Sonia, Paz Lucia, Muñoz Pedro, Hermana Sandra

机构信息

Oncoplastic Breast Unit, Hospital Universitario Valdecilla, University of Cantabria, Santander, Spain.

出版信息

Gland Surg. 2017 Dec;6(6):698-705. doi: 10.21037/gs.2017.06.10.

Abstract

BACKGROUND

Breast conserving surgery (BCS) administered with oncoplastic approach (OBCS), when it is required, is currently the gold standard for the treatment of early breast cancer. Wire-guided localization (WL) is the most popular technique used to help surgeon in breast cancer excision. Currently, a universal and undeniable goal is to minimize the rate of positive margins and re-excision operation after BCS improving cosmetic outcome and decreasing health care costs. This study is aimed to report our experience combining OBCS and tailored WL as surgical approach for early breast cancers.

METHODS

We performed a retrospective study on 148 breast cancer patients who were treated with OBCS and tailored WL, which consists in individualization of the number and location of wires depending on patient particularities, in our Breast Unit from March 2013 to December 2015. A multivariate analysis was used to determine the association between clinic-pathologic variables, which can be known preoperatively, and margin status.

RESULTS

The rate of affected margins was 13.5% and 10.8% patients underwent re-interventions for oncologic reasons. Multifocality was strongly associated with involved margins [odds ratio (OR) 4.67].

CONCLUSIONS

OBCS together with tailored WL obtains an acceptable rate of positive margins and high rate of final BCS.

摘要

背景

保乳手术(BCS)联合肿瘤整形技术(OBCS)在必要时是目前早期乳腺癌治疗的金标准。金属丝引导定位(WL)是帮助外科医生进行乳腺癌切除的最常用技术。目前,一个普遍且不可否认的目标是在保乳手术后将切缘阳性率和再次切除手术率降至最低,以改善美容效果并降低医疗成本。本研究旨在报告我们将肿瘤整形保乳手术和定制金属丝引导定位作为早期乳腺癌手术方法的经验。

方法

我们对2013年3月至2015年12月在我们乳腺科接受肿瘤整形保乳手术和定制金属丝引导定位治疗的148例乳腺癌患者进行了回顾性研究。定制金属丝引导定位是根据患者的具体情况对金属丝的数量和位置进行个体化。采用多变量分析来确定术前已知的临床病理变量与切缘状态之间的关联。

结果

切缘受累率为13.5%,10.8%的患者因肿瘤原因接受了再次干预。多灶性与切缘受累密切相关[比值比(OR)为4.67]。

结论

肿瘤整形保乳手术联合定制金属丝引导定位可获得可接受的切缘阳性率和较高的最终保乳手术成功率。

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