Department of Surgery, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey.
Department of Oncology, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey.
Breast J. 2020 Sep;26(9):1680-1687. doi: 10.1111/tbj.13992. Epub 2020 Jul 30.
Margin status is one of the significant prognostic factors for recurrence in breast-conserving surgery (BCS). The issue that merits consideration for oncologic safety and cost-effectiveness about the modalities to assure clear margins at initial surgical intervention remains controversial after neo-adjuvant chemotherapy (NAC). The presented study aimed to assess the impact of intraoperative ultrasound (IOUS)-guided surgery on accurate localization of tumor site, adequacy of excision with clear margins, and healthy tissue sacrifice in BCS after NAC. Patients who had IOUS-guided BCS ater NAC were reviewed. No patient had preoperative localization with wire or radiotracer. Intraoperative real-time sonographic localization, sonographic margin assessment during resection, macroscopic and sonographic examination of specimen, and cavity shavings (CS) were done as the standard procedure. No frozen assessment was performed. One hundred ninety-four patients were included, in which 42.5% had pCR. IOUS-guided surgery accomplished successful localization of the targeted lesions in all patients. Per protocol, all inked margins on CS specimens were reported to be tumor-free in permanent histopathology. No re-excision or mastectomy was required. For a setting without CS, the negative predictive value (NPV) of IOUS rate was 96%. IOUS was found to over and underestimate tumor response to NAC both in 2% of patients. IOUS-guided surgery seems to be an efficient modality to perform adequate BCS after NAC with no additional localization method. Especially, when CS is integrated as a standard to BCS, IOUS seems to provide safe surgery for patients with no false negativity and a high rate of NPV.
切缘状态是保乳手术（BCS）中复发的一个重要预后因素。新辅助化疗（NAC）后，为确保初始手术干预时切缘清晰，保证肿瘤学安全性和成本效益，各种方法的优劣仍存在争议。本研究旨在评估术中超声（IOUS）引导手术对 NAC 后 BCS 中肿瘤部位的准确定位、切缘充分性和健康组织牺牲的影响。
回顾了接受 IOUS 引导的 NAC 后 BCS 的患者。没有患者接受术前导丝或放射性示踪剂定位。术中实时超声定位、切除过程中的超声切缘评估、标本的宏观和超声检查以及腔隙刮除物（CS）作为标准程序进行。未进行冷冻评估。共纳入 194 例患者，其中 42.5%的患者达到 pCR。IOUS 引导手术成功定位了所有患者的靶向病变。根据方案，所有 CS 标本上的墨渍边缘在永久组织病理学上均报告为无肿瘤。不需要再次切除或乳房切除术。
对于没有 CS 的情况，IOUS 的阴性预测值（NPV）为 96%。IOUS 发现有 2%的患者肿瘤对 NAC 的反应存在高估和低估。
在没有额外定位方法的情况下，IOUS 引导手术似乎是一种有效的方法，可以在 NAC 后进行充分的 BCS。特别是当 CS 作为 BCS 的标准整合时，IOUS 似乎为患者提供了安全的手术，没有假阴性和高 NPV。
