Davies J D, Sharp S, Chinyama C N, Farndon J R, Bates S P, Astley S M
Regional Breast Pathology Unit, University of Bristol, U.K.
J Pathol. 1997 May;182(1):45-53. doi: 10.1002/(SICI)1096-9896(199705)182:1<45::AID-PATH803>3.0.CO;2-R.
There is controversy as to the value of the radiological or pathological estimation of surgical clearance of microcalcifying breast lesions. An important part of this issue has been addressed by coordinated three-dimensional radiographic and histological examination of a prospective consecutive series of 40 benign and malignant mammographically detected lesions in surgical breast biopsy specimens containing microcalcifications, including 20 cases of ductal carcinoma in situ. They were radiographed from four viewpoints by means of rotation in a radiolucent tetrahedral container. The planes of histological examination were then chosen to correspond to the radiographic view showing the minimum separation of the edge of the specimen and the outermost microcalcification. There was a close correlation (Spearman ranked) between the least tetrahedral radiographic distance and the corresponding histological distance separating the surgical margin of excision. There were, however, incompatible Wilcoxon signed ranking orders when comparing the least tetrahedral distance or the histological distance with all four single radiographic views, including the conventional specimen radiographic view. Two-dimensional specimen mammography and standardized histological examination are suboptimal and may thus have contributed to confusion as to the value of determining adequate surgical excision of ductal carcinoma in situ of the breast. Although labour-intensive, use of four-view radiography and choice of the appropriate plane of histological examination give a better correlation of the radiographic estimates of surgical clearance with histology than single-view specimen radiography and arbitrary histological sectioning.
关于乳腺微钙化病变手术切缘的放射学或病理学评估价值存在争议。通过对一系列40例在手术乳腺活检标本中通过乳房X线检查发现的含有微钙化的良性和恶性病变进行三维放射学和组织学联合检查，解决了这个问题的一个重要部分，其中包括20例导管原位癌。通过在一个射线可透过的四面体容器中旋转，从四个角度对它们进行射线照相。然后选择组织学检查平面，使其与显示标本边缘和最外层微钙化之间最小间距的射线照相视图相对应。在最小四面体射线照相距离与相应的将切除手术边缘分开的组织学距离之间存在密切相关性（Spearman等级相关）。然而，在将最小四面体距离或组织学距离与所有四个单一射线照相视图（包括传统标本射线照相视图）进行比较时，存在不兼容的Wilcoxon符号秩次顺序。二维标本乳房X线摄影和标准化组织学检查并不理想，因此可能导致了对于确定乳腺导管原位癌充分手术切除价值的困惑。尽管需要大量人力，但与单视图标本射线照相和任意组织切片相比，四视图射线照相和选择合适的组织学检查平面能使手术切缘的射线照相评估与组织学有更好的相关性。
