Accuracy of ultrasound-guided breast-conserving surgery in the determination of adequate surgical margins
Accuracy of ultrasound-guided breast-conserving surgery in the determination of adequate surgical margins
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DOI：
10.1007/s10549-014-2932-8
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发表时间：
2014-05-01
影响因子：
3.8
通讯作者：
Ignatov, Atanas
中科院分区：
文献类型：
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作者：
Eggemann, Holm;Ignatov, Tanja;Ignatov, Atanas
这项研究的目的是评估在保乳手术(BCS)中，超声测量的切缘的大小与足够的手术切缘相关。这项研究被设计为前瞻性队列研究。纳入接受BCS治疗的原发性浸润性乳腺癌患者。将超声测量的手术切缘与病理切缘进行比较。147例患者符合分析条件。切缘闭合或阳性者21例(14.3%)，再次手术13例(8.8%)。切除体积小、多灶性、绝经后状态、高级别肿瘤相关导管内成分、淋巴管和淋巴结侵犯与切缘阳性的风险增加相关。在研究队列中，测量了882个超声(US)边缘，并观察到与病理边缘有很好的相关性。随着年龄、绝经前状态和导管内成分的增加，超声测量的边缘相对于病理边缘的高估增加。其阳性预测值和阴性预测值分别为81.0、96.2、48.4和99.1%。我们发现，在100%没有高级别导管内成分的肿瘤中，超声估计的千分之四的切缘与千分之一毫米的适当病理切缘相关。然而，这并不适用于肿瘤相关的高级别导管内成分，在100%的病例中，US边缘为14 mm与清晰的病理边缘相关。术中超声检查是获得BCS手术切缘清晰的安全可行的方法。
The goal of this study was to assess the size of the ultrasound-measured margin associated with an adequate surgical margin during breast-conserving surgery (BCS). The study was designed as a prospective cohort study. Patients with primary invasive breast cancer undergoing BCS were included. The ultrasound-measured surgical margins were compared with the pathological margins. 147 patients were eligible for analysis. 21 (14.3 %) patients had close or positive resection margins and 13 (8.8 %) underwent a second operation. Small excision volume, multifocality, postmenopausal status, high grade tumor-associated intraductal component, and invasion of lymph vessels and lymph nodes were associated with increased risk of positive excision margins. In the study cohort, 882 Ultrasonography (US) margins were measured and a good correlation to the pathological margins was observed. Overestimation of the US-measured margins relative to the pathological margins was increased with younger age, premenopausal status, and intraductal component. The estimated positive and negative predictive values, sensitivity and specificity were 81.0, 96.2, 48.4, and 99.1 %, respectively. We found that a sonographically estimated margin of a parts per thousand yen4 mm was associated with an adequate pathological margin of a parts per thousand yen1 mm in 100 % of tumors that did not have a high grade intraductal component. However, this was not applicable for tumor-associated high grade intraductal component where a US margin of 14 mm was associated with clear pathological margins in 100 % of cases. Intraoperative ultrasonography is a safe and feasible method to obtain clear surgical margins by BCS.