Department of Radiology, Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114.
Department of Surgery, Massachusetts General Hospital, Boston, MA.
AJR Am J Roentgenol. 2021 Sep;217(3):605-612. doi: 10.2214/AJR.20.24374. Epub 2020 Oct 21.
Advantages of radiofrequency tags for preoperative breast lesion localization include decoupling of tag placement from surgical schedules and improved patient comfort. The purpose of this study was to evaluate the feasibility of a preoperative localization radiofrequency tag system for breast lesions requiring surgical excision. The cohort for this retrospective study included consecutive patients who underwent image-guided needle localization with radiofrequency tags before surgical excision from July 12, 2018, to July 31, 2019. Images and medical records were reviewed to evaluate the pathologic diagnoses serving as indications for tag placement, imaging guidance for tag placement, number of tags placed, and target lesion type. Tag placement technical accuracy rate (defined as deployment of the tag within 1 cm of the edge of the target), success (defined as technical accuracy without complication), and surgical margin and reexcision status were evaluated. A total of 1013 tags were placed under imaging guidance in 848 patients (mean age, 60 years; range, 23-96 years) and 847 subsequently underwent surgical excision. Tags were most commonly placed for invasive carcinoma (537/1013, 53.0%), ductal carcinoma in situ (138/1013, 13.6%), and high-risk lesions (289/1013, 28.5%). A total of 673 (66.4%) tags were deployed under mammographic guidance, whereas 340 (33.6%) were placed under sonographic guidance. Two or more tags were placed in 149 of 848 patients (17.6%). Targeted lesion types primarily included masses (448/1013, 44.2%), biopsy clip markers (331/1013, 32.7%), and calcifications (155/1013, 15.3%). Technical accuracy of placement was achieved in 1004 (99.1%) tags. Of the nine inaccurate tag placements, seven (77.8%) required an additional tag or wire placement. Seven (0.7%) biopsy clip markers were displaced within the breast or removed by the tag device during placement. No complications were reported intraoperatively. Therefore, success was achieved in 997 (98.4%) tags. Tags were successfully retrieved in all 847 patients who underwent surgery. Of the 568 patients with a preoperative diagnosis of carcinoma, 86 (15.1%) had positive or close surgical margins requiring surgical reexcision. Preoperative image-guided localization with radiofrequency tags is a safe and feasible technique for breast lesions requiring surgery. Radiofrequency tag localization is an acceptable alternative to needle or wire localization, offering the potential for improved patient workflow and experience.
术前乳腺病变定位用射频标记的优点包括将标记放置与手术计划脱钩以及提高患者舒适度。本研究的目的是评估用于需要手术切除的乳腺病变的术前定位射频标记系统的可行性。本回顾性研究的队列包括 2018 年 7 月 12 日至 2019 年 7 月 31 日期间因图像引导下的针定位而接受射频标记的连续患者。回顾性分析图像和病历，以评估作为放置标记适应证的病理诊断、放置标记的影像学引导、放置的标记数量以及目标病变类型。评估标记放置的技术准确性率（定义为标记部署在目标边缘 1cm 内）、成功率（定义为无并发症的技术准确性）以及手术切缘和再次切除状态。在 848 例患者（平均年龄 60 岁；范围 23-96 岁）中，共在影像学引导下放置了 1013 个标记，随后 847 例患者接受了手术切除。标记最常用于浸润性癌（537/1013，53.0%）、导管原位癌（138/1013，13.6%）和高危病变（289/1013，28.5%）。673（66.4%）个标记是在乳房 X 线摄影引导下放置的，而 340（33.6%）个标记是在超声引导下放置的。848 例患者中有 149 例（17.6%）放置了两个或更多标记。目标病变类型主要包括肿块（448/1013，44.2%）、活检夹标记（331/1013，32.7%）和钙化（155/1013，15.3%）。放置的 1004 个（99.1%）标记达到了技术准确性。在 9 个不准确的标记放置中，有 7 个（77.8%）需要额外的标记或导丝放置。在放置过程中，有 7 个（77.8%）活检夹标记在乳房内移位或被标记装置移除。术中无并发症报告。因此，997 个（98.4%）标记成功。所有接受手术的 847 例患者均成功取出标记。在 568 例术前诊断为癌的患者中，有 86 例（15.1%）存在需要再次手术切除的阳性或接近切缘。术前影像学引导下的射频标记定位是一种安全可行的乳腺病变手术方法。射频标记定位是一种可接受的替代针或导丝定位的方法，具有改善患者工作流程和体验的潜力。
