Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
The Breast Imaging Unit, Tel Aviv Soursaky Medical Center, Tel Aviv, Israel.
Ann Surg Oncol. 2021 Sep;28(9):4974-4980. doi: 10.1245/s10434-021-09800-7. Epub 2021 Mar 6.
Needle localization of a marking clip is required to guide accurate removal of many breast lesions. When the clip is not visualized on specimen radiography, concerns regarding the completeness of cancer removal and long-term outcomes arise. Using a large cohort of women undergoing breast conservation, we examined the magnitude of the problem and the outcome of women with a missing clip.
We conducted a case-control study including all women undergoing mammographic wire-guided localization between 2013 and 2018 with a specimen radiograph showing a missing clip. The control group included women with successful removal of the clip(s). Data included demographics, cancer and treatment characteristics, and outcome. The groups were compared in regard to margin status, repeat surgery, and recurrence rates.
The research group included 43 women [5% of the cohort; 95% confidence interval (CI) 3.9-7.2] with a missing clip. Positive margins were comparable (7, 17% of cases; 29, 15% of 196 cases in the control group; p = 0.96). Eleven women (33%) had a residual clip visualized on post-operative mammography; in four cases, a percutaneous biopsy of the clip was successful, all with no residual tumor. There was no significant difference in re-excision rates (14% vs. 8%, p = 0.23) or in local or distant recurrence.
In the majority of women with a missing clip, the clip is not visualized on post-operative mammography. Those with a residual clip can be managed with percutaneous biopsy as long as the lesion was removed with clear margins, with comparable outcomes as women in whom the clip is visualized on specimen radiograph.
为了指导准确切除许多乳腺病变，需要对标记夹进行针定位。当标本放射照相术无法观察到夹时，会引起对癌症切除的完整性和长期结果的担忧。我们使用了一组接受保乳手术的大量女性患者，研究了该问题的严重程度以及夹缺失的女性患者的结果。
我们进行了一项病例对照研究，包括所有在 2013 年至 2018 年间接受乳腺导丝定位的女性患者，其标本放射照相术显示夹缺失。对照组包括成功切除夹的女性患者。数据包括人口统计学，癌症和治疗特征以及结果。比较了两组的切缘状态，重复手术和复发率。
研究组包括 43 名女性（队列的 5%；95%置信区间[CI] 3.9-7.2）夹缺失。阳性切缘相似（7 例；17%的病例；29 例；对照组 196 例中的 15%；p=0.96）。11 名女性（33%）在术后乳房 X 线照相术上可见残留夹；在 4 例中，经皮夹活检成功，均无残留肿瘤。再次切除率无显着差异（14%对 8%，p=0.23）或局部或远处复发。
在大多数夹缺失的女性中，术后乳房 X 线照相术无法观察到夹。只要病变切除边缘清晰，夹残留的患者可以通过经皮活检进行管理，其结果与标本放射照相术上观察到夹的女性患者相似。
