Radioactive Seed Localization Versus Wire Localization for Lumpectomies: A Comparison of Outcomes
Radioactive Seed Localization Versus Wire Localization for Lumpectomies: A Comparison of Outcomes
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DOI：
10.2214/ajr.14.12743
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发表时间：
2015-04-01
影响因子：
5
通讯作者：
Ganott, Marie A.
中科院分区：
文献类型：
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作者：
Sharek, Danielle;Zuley, Margarita L.;Ganott, Marie A.
OBJECTIVE.本研究的目的是比较放射性粒子定位（RSL）与导丝定位的结果，使用手术切缘大小，再切除率和再手术率，标本大小，放射资源利用率和美观作为measures.Materials和方法。从2011年4月1日至2012年3月1日，选择在部分乳房切除术前接受RSL的患者，活检证实为癌症。每个病例都使用肿瘤大小、类型和外科医生与导丝定位对照病例相匹配，共232例病例。比较了最近手术边缘的宽度、再切除率和再手术率，以及肿瘤体积与初始手术标本体积的比率和肿瘤体积与所有手术切除体积（包括再切除和再手术）的比率。通过比较哈佛评分和标本体积与乳房体积来分析美容效果。比较RSL实施前后放射学资源利用情况。两种方法在最接近手术切缘方面无显著差异（RSL平均值，0.45 cm;导丝定位平均值，0.45 cm; p = 0.972），再切除率（RSL平均值，21.1%;导丝定位平均值，26.3%; p = 0.360），再次手术率（RSL，11.4%;导丝定位，12.7%; p = 0.841），肿瘤体积与初始手术标本体积的比值（RSL平均值，0.027;导丝定位平均值，0.028; p = 0.886），肿瘤体积与切除总体积的比值（RSL平均值，0.024;导丝定位平均值，0.024; p = 0.997），或临床或计算的美观评分（临床p = 0.5;计算p = 0.060）。在RSL制度实施后，计划活检时隙利用率增加了34%，计划时间节省了50%，活检等待时间平均减少了4.1天。RSL是导丝定位的可接受替代方案，并在工作流程中提供了显著改进。
OBJECTIVE. The purpose of this study was to compare outcomes of radioactive seed localization (RSL) versus wire localization using surgical margin size, reexcision and reoperation rates, specimen size, radiology resource utilization, and cosmesis as measures.MATERIALS AND METHODS. Patients who underwent RSL before segmental mastectomy from April 1, 2011, to March 1, 2012, for biopsy-proven cancer were selected. Each was matched using tumor size, type, and surgeon to a wire localization control case, resulting in 232 cases. Width of the closest surgical margin, reexcision rate, and reoperation rate were compared as were the ratios of tumor volume to initial surgical specimen volume and tumor volume to all surgically excised volume (including reexcisions and reoperations). Cosmetic outcome was analyzed by comparison of Harvard scores and specimen volume with breast volume. Radiology resource utilization was compared before and after RSL implementation.RESULTS. No significant differences between methods were found in closest surgical margin (RSL mean, 0.45 cm; wire localization mean, 0.45 cm; p = 0.972), reexcision rate (RSL mean, 21.1%; wire localization mean, 26.3%; p = 0.360), reoperation rate (RSL, 11.4%; wire localization, 12.7%; p = 0.841), ratio of the tumor volume to initial surgical specimen volume (RSL mean, 0.027; wire localization mean, 0.028; p = 0.886), ratio of the tumor volume to total volume resected (RSL mean, 0.024; wire localization mean, 0.024; p = 0.997), or in clinical or computed cosmesis scores (clinical p = 0.5; calculated p = 0.060). There was a 34% increase in scheduled biopsy slot utilization, 50% savings in time spent scheduling, and a 4.1-day average decrease in biopsy wait time after RSL institution.CONCLUSION. RSL is an acceptable alternative to wire localization and offers significant improvements in workflow.