Madeley Carolyn, Kessell Meredith, Madeley Chris, Taylor Donna
Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.
Breast Screen Western Australia, Perth, Western Australia, Australia.
J Med Radiat Sci. 2019 Sep;66(3):170-176. doi: 10.1002/jmrs.348. Epub 2019 Jul 25.
Impalpable breast cancers require precise pre-operative lesion localisation to minimise re-excision rates. Conventional techniques include hookwire insertion using stereotactic guidance. Newer techniques include the use of tomosynthesis guidance and the use of iodine-125 seeds. This study compares the accuracy of lesion localisation with hookwire or seed insertion using prone stereotactic or upright tomosynthesis guidance.
This registered quality improvement activity did not require formal ethics approval. The post-localisation images for 116 lesions were reviewed. The distance from the lesion or breast biopsy marker to the hookwire or seed was measured on post-insertion mammograms. The relative placement accuracy of hookwire or seed using prone stereotactic or upright tomosynthesis guidance was compared. A lesion to seed or wire distance > 10 mm was considered technically unsatisfactory.
94.8% of the seeds and wires inserted via prone stereotactic guidance were accurately placed, compared with 89.6% of those inserted via upright tomosynthesis. There were twice as many technically unsatisfactory insertions under upright tomosynthesis guidance. The majority of the unsatisfactory insertions using upright tomosynthesis occurred when the lesion was at or below the level of the nipple and the insertion was performed craniocaudally.
The degree of accuracy of pre-operative localisation of impalpable breast lesions is significantly higher with the use of prone stereotactic rather than upright tomosynthesis guidance. This was most evident with the placement of I-125 seeds, and in cases where the target lesion was located below the level of the nipple.
不可触及的乳腺癌需要精确的术前病变定位，以尽量降低再次切除率。传统技术包括在立体定向引导下插入钩丝。较新的技术包括使用断层合成引导和使用碘-125种子。本研究比较了在俯卧位立体定向或直立位断层合成引导下，使用钩丝或种子插入进行病变定位的准确性。
这项注册的质量改进活动无需正式伦理批准。回顾了116个病变的定位后图像。在插入后的乳房X线照片上测量病变或乳房活检标记物到钩丝或种子的距离。比较了在俯卧位立体定向或直立位断层合成引导下钩丝或种子的相对放置准确性。病变到种子或钢丝的距离>10mm被认为在技术上不满意。
通过俯卧位立体定向引导插入的种子和钢丝中，94.8%放置准确，而通过直立位断层合成插入的为89.6%。在直立位断层合成引导下，技术上不满意的插入次数是前者的两倍。使用直立位断层合成时，大多数不满意的插入发生在病变位于乳头水平或以下且插入是在头尾方向进行时。
使用俯卧位立体定向引导而非直立位断层合成引导对不可触及的乳腺病变进行术前定位的准确性显著更高。这在I-125种子的放置以及目标病变位于乳头水平以下的情况下最为明显。
