Graham R A, Homer M J, Sigler C J, Safaii H, Schmid C H, Marchant D J, Smith T J
Department of Surgery, Tufts University School of Medicine, New England Medical Center Hospitals, Boston, MA 02111.
AJR Am J Roentgenol. 1994 Jan;162(1):33-6. doi: 10.2214/ajr.162.1.8273685.
The purpose of this study was to determine if the presence or absence of tumor at the surgical margin in cases of impalpable breast carcinoma could be predicted accurately with specimen radiography.
We obtained single-view radiographs of 119 consecutive surgical biopsy specimens of impalpable invasive or in situ ductal carcinoma. Radiographic lesions were classified as a mass with moderately well defined margins, a mass with poorly defined margins, or microcalcifications without an associated mass. The radiographic appearance of the impalpable cancer, the margin as judged from the specimen radiograph, the tumor's histologic appearance, and the histologic appearance of the tumor margin were then correlated.
Specimen radiographs showed tumor at the surgical margin in 63 cases; 62 of these were confirmed histologically (positive predictive value, 98%). Specimen radiographs showed tumor-free surgical margins in 56 cases; 18 of these were confirmed histologically (negative predictive value, 32%). These results were independent of the radiographic appearance of the lesion or the tumor's histologic appearance.
Decisions based on findings on specimen radiographs were valid only if the radiographs showed tumor at the margin of the specimen.
本研究旨在确定乳腺钼靶检查能否准确预测不可触及性乳腺癌手术切缘有无肿瘤残留。
我们对119例连续的不可触及性浸润性或原位导管癌手术活检标本进行了单视图X线摄影。X线摄影病变分为边缘中度清晰的肿块、边缘不清的肿块或无相关肿块的微钙化。然后将不可触及性癌的X线表现、根据标本X线片判断的切缘情况、肿瘤的组织学表现以及肿瘤切缘的组织学表现进行关联分析。
标本X线片显示63例手术切缘有肿瘤；其中62例经组织学证实（阳性预测值为98%）。标本X线片显示56例手术切缘无肿瘤；其中18例经组织学证实（阴性预测值为32%）。这些结果与病变的X线表现或肿瘤的组织学表现无关。
只有当X线片显示标本边缘有肿瘤时，基于标本X线片结果做出的决策才是有效的。
