Recanatini L, Renoldi L, Sfondrini M S, Di Nubila B, Marzano L, Poma S, Landini A
Servizio di Radiodiagnostica e di Radioterapia, Clinica Mangiagalli, Milano.
Radiol Med. 1998 May;95(5):445-8.
Mammography and US increase the rate of early breast cancer diagnoses. The difficult intraoperative location of nonpalpable lesions has led to the development of various techniques suitable to this purpose. We investigated the effectiveness of free-hand vegetable charcoal lesion marking during both mammography and US and compared this technique with other more commonly used methods.
Our series consisted of 485 consecutive charcoal markings of nonpalpable breast lesions submitted to histologic examination. Marking was carried out free-hand under mammographic guidance in 392 cases and under US guidance in 93 cases. The technique, presented in the paper with schematic drawings, was successful because the surgeon correctly identified the charcoal tracing in all 485 cases. There were no complications, neither during charcoal introduction nor during surgery.
The comparison with other marking techniques showed the following advantages of our method: 1) it is rapid and easy to perform; 2) patient discomfort is minimal and no local anesthesia is needed; 3) it is accurate and there are no risks of charcoal displacement or spread; 4) the tracing charcoal is easy to find; 5) the most appropriate surgical route can be followed, with consequently better cosmetic results in the patients not undergoing quadrantectomy; 6) surgery can be performed on an outpatient basis under local anesthesia; 7) a minimal amount of glandular tissue is removed; 8) there are absolutely no side-effects; 9) cost is low; 10) surgery can be planned over time; 11) there is no risk of cutting the wire with an electrotome; 12) no particular equipment or instruments are needed; 13) there are no problems in very superficial lesions.
To conclude, on account of our results and of so many advantages, we believe that free-hand vegetable charcoal marking during mammography and US is now the best possible solution to the problem of surgical identification of nonpalpable breast lesions.
乳腺钼靶摄影和超声检查提高了早期乳腺癌的诊断率。不可触及病变在术中定位困难，促使人们开发了各种适用于此目的的技术。我们研究了在乳腺钼靶摄影和超声检查过程中徒手用植物炭标记病变的有效性，并将该技术与其他更常用的方法进行了比较。
我们的系列研究包括485例连续的不可触及乳腺病变的炭标记，并进行了组织学检查。392例在乳腺钼靶引导下徒手进行标记，93例在超声引导下进行标记。本文用示意图展示了该技术，该技术是成功的，因为在所有485例病例中外科医生都能正确识别炭迹。在注入炭剂过程中及手术过程中均无并发症发生。
与其他标记技术的比较显示了我们方法的以下优点：1）操作快速简便；2）患者不适最小，无需局部麻醉；3）准确无误，不存在炭剂移位或扩散的风险；4）易于找到追踪炭剂；5）可以采用最合适的手术路径，因此对于未接受象限切除术的患者可获得更好的美容效果；6）手术可在局部麻醉下作为门诊手术进行；7）切除的腺体组织量最少；8）绝对没有副作用；9）成本低；10）手术可提前安排时间；11）不存在用电刀切断金属丝的风险；12）无需特殊设备或器械；13）对于非常表浅的病变不存在问题。
综上所述，基于我们的结果和诸多优点，我们认为在乳腺钼靶摄影和超声检查过程中徒手用植物炭标记是目前解决不可触及乳腺病变手术识别问题的最佳方案。
