高频超声辅助 Mohs 显微外科手术治疗隆突性皮肤纤维肉瘤。

High-frequency ultrasound-assisted Mohs micrographic surgery for the treatment of dermatofibrosarcoma protuberans.

机构信息

Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.

National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; Department of Burn, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.

出版信息

J Plast Reconstr Aesthet Surg. 2024 Sep;96:186-195. doi: 10.1016/j.bjps.2024.07.013. Epub 2024 Jul 17.

DOI:10.1016/j.bjps.2024.07.013

PMID:39094373

Abstract

BACKGROUND

Dermatofibrosarcoma protuberans (DFSP) is a superficial sarcoma characterized by infiltrative growth with tentacle-like borders. Mohs micrographic surgery (MMS) is the preferred treatment option for DFSP. However, the imprecise boundary localization in MMS leads to an increased number of Mohs layers required and a longer surgery time. High-frequency ultrasound has excellent tissue recognition capability for DFSP, allowing for precise boundary marking.

MATERIALS AND METHODS

In this study, we retrospectively analyzed 14 cases of DFSP treated with MMS using preoperative ultrasound localization and three-dimensional reconstruction at Xiangya Hospital over the past 5 years. We also reviewed previous studies on MMS for DFSP treatment.

RESULTS

It was found that the average number of Mohs layers for patients after preoperative ultrasound localization was 1.57, ranging from 1 to 3, which was less than the previously reported 1.86 layers, ranging from 1 to 12. This effectively reduced the number of Mohs layers required.

CONCLUSIONS

By utilizing preoperative high-frequency ultrasound to determine the boundaries and depth of DFSP, the number of Mohs layers can be effectively reduced, leading to less workload for pathological examination, shorter operation time, and reduced surgical risks for patients. Ultrasound imaging data can be used for three-dimensional reconstruction, enabling less experienced Mohs surgeons to have a visual understanding of the morphology and extent of infiltration of the lesions. This aids in developing optimal surgical plans, smoothing the learning curve, and promoting the wider adoption of MMS.

摘要

背景

隆突性皮肤纤维肉瘤（DFSP）是一种具有触须样边界的浸润性生长的浅表肉瘤。Mohs 显微外科手术（MMS）是 DFSP 的首选治疗方案。然而，MMS 中边界定位不精确导致需要更多的 Mohs 层，手术时间延长。高频超声对 DFSP 具有出色的组织识别能力，能够实现精确的边界标记。

材料和方法

本研究回顾性分析了过去 5 年在湘雅医院采用术前超声定位和三维重建的 14 例 MMS 治疗的 DFSP 患者。我们还回顾了以前关于 MMS 治疗 DFSP 的研究。

结果

发现术前超声定位后患者的 Mohs 层平均为 1.57 层，范围为 1-3 层，少于以前报道的 1.86 层，范围为 1-12 层。这有效地减少了所需的 Mohs 层数量。

结论

通过利用术前高频超声确定 DFSP 的边界和深度，可以有效地减少 Mohs 层的数量，减少病理检查的工作量，缩短手术时间，降低患者的手术风险。超声成像数据可用于三维重建，使经验较少的 Mohs 外科医生能够直观地了解病变的形态和浸润范围。这有助于制定最佳手术计划，平滑学习曲线，并促进 MMS 的更广泛应用。