触诊阴性乳腺癌的切缘和局部复发：放射引导隐匿性病灶定位术（ROLL）与放射性粒子定位术（RSL）的比较。
Resection margins and local recurrences of impalpable breast cancer: Comparison between radioguided occult lesion localization (ROLL) and radioactive seed localization (RSL).
机构信息
Breast Surgery Unit, Comprehensive Cancer Center, University of Helsinki, Helsinki University Hospital Finland, P.O. Box 263, 00029, HUS, Finland.
HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, HUS, Finland.
出版信息
Breast. 2019 Oct;47:93-101. doi: 10.1016/j.breast.2019.07.004. Epub 2019 Jul 23.
OBJECTIVES
The aim of this retrospective study is to compare surgical margins, reoperation rates and local recurrences after breast conserving surgery (BCS) using radioguided occult lesion localization (ROLL) or radioactive seed localization (RSL).
MATERIALS AND METHODS
We reviewed 744 consecutive patients with impalpable primary invasive breast cancer who underwent BCS at Helsinki University Hospital between 2010 and 2012. ROLL was used in our unit until October 31st, 2011; from November 1st we changed localization method to RSL.
RESULTS
318 patients underwent ROLL and 426 RSL. Patients in the RSL group had more often multifocal (p = 0.013) tumours. No statistically significant differences were found regarding tumour size, specimen weight, histology or grade of tumours or lymph node status. 42 (5.6%) patients were reoperated because of insufficient margins, 13 (4.1%) in the ROLL group and 29 (6.8%) in the RSL group. The reoperation rate was not different between the groups either in the univariable analysis (p = 0.112) or in the multivariable binary logistic regression analysis (p = 0.204). Risk factors for reoperations were multifocality of the tumour (p < 0.001), extensive intraductal component (p < 0.001), larger tumour size (p = 0.011), and smaller specimen weight (p = 0.014). The median follow-up time in the ROLL group was 81 (8-94) months and 64 (3-73) months in the RSL group. The five-year local recurrence-free survival (LRFS) estimates for ROLL and RSL groups were 98.0% and 99.4%, respectively (log-rank test, p = 0.323).
CONCLUSION
Reoperation rates and LRFS were comparable for ROLL and RSL in patients with impalpable breast cancer treated with BCS.
目的
本回顾性研究旨在比较使用放射性示踪隐匿性病灶定位（ROLL）或放射性种子定位（RSL）行保乳手术后的手术切缘、再次手术率和局部复发率。
材料与方法
我们回顾了 2010 年至 2012 年期间在赫尔辛基大学医院行保乳术的 744 例不可触及原发性浸润性乳腺癌连续患者。我们的单位于 2011 年 10 月 31 日之前使用 ROLL，自 2011 年 11 月 1 日起，我们将定位方法更改为 RSL。
结果
318 例行 ROLL，426 例行 RSL。RSL 组患者的肿瘤多灶性更为常见（p=0.013）。肿瘤大小、标本重量、组织学或分级或淋巴结状态方面无统计学差异。42 例（5.6%）患者因切缘不足而再次手术，ROLL 组 13 例（4.1%），RSL 组 29 例（6.8%）。单变量分析（p=0.112）或多变量二项逻辑回归分析（p=0.204）均显示两组间再次手术率无差异。再次手术的危险因素包括肿瘤多灶性（p<0.001）、广泛的导管内成分（p<0.001）、肿瘤较大（p=0.011）和标本重量较小（p=0.014）。ROLL 组的中位随访时间为 81（8-94）个月，RSL 组为 64（3-73）个月。ROLL 组和 RSL 组的 5 年局部无复发生存率（LRFS）估计值分别为 98.0%和 99.4%（对数秩检验，p=0.323）。
结论
在接受保乳术治疗的不可触及乳腺癌患者中，ROSL 和 RSL 的再次手术率和 LRFS 相当。
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