DeBiose D A, Horwitz E M, Martinez A A, Edmundson G K, Chen P Y, Gustafson G S, Madrazo B, Wimbish K, Mele E, Vicini F A
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Int J Radiat Oncol Biol Phys. 1997 Jul 1;38(4):755-9. doi: 10.1016/s0360-3016(97)00069-2.
To determine the value of breast ultrasonography (US) in defining the lumpectomy cavity for patients treated with interstitial brachytherapy.
In March 1993, a protocol of low dose rate (LDR) interstitial brachytherapy as the sole radiation modality in selected patients with early breast cancer was initiated at William Beaumont Hospital. To date, 60 patients have been entered in this protocol, and 38 have undergone US assisted placement of interstitial brachytherapy needles. The lumpectomy cavity was outlined in all dimensions and corresponding skin marks were placed for reference at time of implantation. These US dimensions were compared to the physician's clinical estimate of the location of the lumpectomy cavity, the patient's presurgical mammogram, and the position of the surgical scar. In the intraoperative setting, the dimensions of the lumpectomy cavity were also obtained and the placement of the deep plane of interstitial needles was verified by US.
The full extent of the lumpectomy cavity was underestimated by clinical examination (physical exam, operative report, mammographic information and location of the surgical scar) in 33 of 38 patients (87%). The depth to the chest wall was also incorrectly estimated in 34 (90%) patients when compared to US examination. Intraoperatively, US was performed in nine patients and was useful in verifying the accurate placement of the deepest plane of interstitial brachytherapy needles. In 7 of 9 patients (75%), clinical placement of needles did not ensure adequate coverage of the posterior extent of the lumpectomy cavity as visualized by intraoperative US.
In breast cancer patients considered for interstitial brachytherapy, US appears to be a more accurate means of identifying the full extent of the lumpectomy cavity when compared to clinical estimates. In addition, US allows real-time verification of needle placement in the intraoperative setting.
确定乳腺超声检查（US）在为接受组织间近距离放射治疗的患者确定乳房肿块切除术腔方面的价值。
1993年3月，威廉·博蒙特医院启动了一项低剂量率（LDR）组织间近距离放射治疗作为选定早期乳腺癌患者唯一放疗方式的方案。迄今为止，60名患者已纳入该方案，38名患者接受了超声辅助下组织间近距离放射治疗针的放置。在植入时，勾勒出肿块切除术腔的所有维度，并放置相应的皮肤标记以供参考。将这些超声测量的维度与医生对肿块切除术腔位置的临床估计、患者术前的乳房X线照片以及手术疤痕的位置进行比较。在术中，还获取了肿块切除术腔的维度，并通过超声验证组织间针深平面的放置情况。
38名患者中有33名（87%）的肿块切除术腔的完整范围被临床检查（体格检查、手术报告、乳房X线照片信息和手术疤痕位置）低估。与超声检查相比，34名（90%）患者的胸壁深度也被错误估计。术中，对9名患者进行了超声检查，有助于验证组织间近距离放射治疗针最深平面的准确放置。在9名患者中的7名（75%）中，术中超声显示临床针的放置未能确保肿块切除术腔后部范围得到充分覆盖。
对于考虑接受组织间近距离放射治疗的乳腺癌患者，与临床估计相比，超声似乎是一种更准确的确定肿块切除术腔完整范围的方法。此外，超声可在术中实时验证针的放置情况。
