Surgeon performed continuous intraoperative ultrasound guidance decreases re-excisions and mastectomy rates in breast cancer
Surgeon performed continuous intraoperative ultrasound guidance decreases re-excisions and mastectomy rates in breast cancer
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DOI：
10.1016/j.breast.2017.02.014
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发表时间：
2017-06-01
期刊：
影响因子：
3.9
通讯作者：
Ozkan, Selcuk
中科院分区：
文献类型：
--
作者：
Cakmak, Guldeniz Karadeniz;Emre, Ali U.;Ozkan, Selcuk
背景：术中超声引导（IUG）保乳手术（BCS）越来越受到全世界乳腺外科医生的欢迎。我们的目的是比较 IUG-BCS 对可触及和不可触及乳腺癌在切缘状态、再切除率、组织牺牲和成本时间分析方面的疗效。方法：术中定位方案包括切除前的术中超声定位病灶并指导初次切除。然后对切除的标本进行目视和触诊检查，并用超声波检查标本和空腔。常规从切除标本的所有六个面的一部分获取冰冻切片，并将剃除的腔体边缘送去进行永久组织学检查。结果：在208名患者中，57.2%患有不可触及的肿瘤。超声定位的灵敏度为100%。初次手术时，92.43% 的不可触及病变和 91.01% 的可触及病变实现了阴性切缘。 95.4% 的病例中，外科医生通过超声检查标本正确识别了受累边缘。最终正保证金率为2.4%。计算的切除率和时间分析没有发现任何显着的结果。结论：IUG-BCS 是一种宝贵且有效的方法，可以获得清晰的手术切缘、最佳切除体积和减少再次手术。此外，通过该算法，在切除肿瘤床的腔边缘进行永久分析的情况下，可以省略冰冻切片评估。 (C) 2017 Elsevier Ltd. 保留所有权利。
Background: Intraoperative ultrasound guided (IUG) breast conserving surgery (BCS) is being increasingly embraced by breast surgeons worldwide. We aimed to compare the efficacy of IUG-BCS for palpable and nonpalpable breast cancer with respect to margin status, re-excision rate, tissue sacrifice and cost time analysis.Methods: Intraoperative localization protocol includes intraoperative ultrasound prior to excision to localize the lesion and guide the initial resection. The excised specimen was then examined visually and by palpation and the specimen and cavity was examined with ultrasound. Frozen sections were obtained routinely from a portion of all six faces of the resected specimen, and shaved cavity margins were sent for permanent histology.Results: Of the 208 patients, 57.2% had nonpalpable tumors. The sensitivity of ultrasound localization was 100%. Negative margins were achieved in 92.43% of nonpalpable and 91.01% of palpable lesions at initial procedure. The involved margins were correctly identified by the surgeon via specimen sonography in 95.4% of cases. Final positive margin rate was 2.4%. Calculated resection ratio and time analysis revealed nothing significant.Conclusion: IUG-BCS is an invaluable and effective modality for obtaining clear surgical margins with optimum resection volumes and reducing re-operations. Furthermore, by means of this algorithm, in case of shaving cavity margins of the tumor bed for permanent analysis, frozen section evaluation might be omitted. (C) 2017 Elsevier Ltd. All rights reserved.