放射性粒子定位与金属丝定位引导切除隐匿性乳腺病变
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摘要
目的对比分析放射性粒子定位(RSL)与金属丝定位(WL)引导切除隐匿性乳腺病变的效果,探讨RSL的应用价值。方法收集72例女性隐匿性乳腺病变患者,对其中34例行RSL(于术前5天内进行定位,RSL组)、38例行WL(于手术当日完成定位,WL组),而后均以手术切除病灶。对比2组定位准确率、首次切缘阴性率、病灶再切除率及定位相关并发症发生情况。结果2组均定位准确,乳腺X线片示病灶均完整切除。RSL组首次切缘阴性率为91.18%(31/34),病灶再切除率为5.88%(2/34);WL组分别为65.79%(25/38)和28.95%(11/38);2组间差异均有统计学意义(P均<0.01)。WL组术中出现金属丝移位2例、迷走神经反应1例,RSL组未出现明显并发症。结论 RSL、WL均可准确定位并引导切除隐匿性乳腺病变;与WL比较,RSL不受手术时间影响,不易移位,切缘阴性率低,定位相关并发症少。
Objective To compare the efficacy of radioactive seed localization(RSL)and wire-guided localization(WL)for intraoperative localization of non-palpable breast lesions,and to observe the application value of RSL.Methods Totally72 women with non-palpable breast lesions who would underwent breast-conserving surgery were enrolled and divided into RSL group(n=34)and WL group(n=38).WL was performed at the same day as surgical excision,while RSL was performed within 5days before the surgery.The precision rate of location,the rates of tumor-free margin and re-excision,as well as the localization-related complications were compared between the two groups.Results All lesions were precisely located and completely removed.The tumor-free margin rate and the re-excision rate of RSL was 91.18%(31/34)and5.88%(2/34),while of WL was 65.79%(25/38)and 28.95%(11/38),respectively.There were significant differences between the two groups(both P<0.01).In WL group,2cases occurred wire shifting,1case had the vagus nerve response,while no localization-related complication occurred in RLS group.Conclusion Both RSL and WL can be used for accurate localization and guided-resection of non-palpable breast lesions.Compared with WL,positioning of RSL is not affected by operation time,which has higher tumor-free margin rate and lower re-excision rate.
Objective To compare the efficacy of radioactive seed localization(RSL)and wire-guided localization(WL)for intraoperative localization of non-palpable breast lesions,and to observe the application value of RSL.Methods Totally72 women with non-palpable breast lesions who would underwent breast-conserving surgery were enrolled and divided into RSL group(n=34)and WL group(n=38).WL was performed at the same day as surgical excision,while RSL was performed within 5days before the surgery.The precision rate of location,the rates of tumor-free margin and re-excision,as well as the localization-related complications were compared between the two groups.Results All lesions were precisely located and completely removed.The tumor-free margin rate and the re-excision rate of RSL was 91.18%(31/34)and5.88%(2/34),while of WL was 65.79%(25/38)and 28.95%(11/38),respectively.There were significant differences between the two groups(both P<0.01).In WL group,2cases occurred wire shifting,1case had the vagus nerve response,while no localization-related complication occurred in RLS group.Conclusion Both RSL and WL can be used for accurate localization and guided-resection of non-palpable breast lesions.Compared with WL,positioning of RSL is not affected by operation time,which has higher tumor-free margin rate and lower re-excision rate.
引文
[1]刘琳,周庆华,王忠敏,等.临床不能触及乳腺病变影像引导下导丝定位手术切检的研究.介入放射学杂志,2014,23(12):1088-1091.
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[8]赵凯华,李培莹,谭政帅,等.乳腺癌分子亚型的影像特征与保乳手术再切除率的相关性研究.临床肿瘤学杂志,2017,22(7):628-632.
[9] Fung F, Cornacchi SD, Reedijk M,et al. Breast cancer recurrence following radioguided seed localization and standard wire localization of non-palpable invasive and in situ breast cancers:5-year follow-up from a randomized controlled trial.Am J Surg,2017,213(4):798-804.
[10] Hwang E,Kamen J,Sonnenblick EB,et al.Localization of image-detectedbreastabnormalities:Radioactiveseed localization—an alternative to wire localization.J Radiol Nurs,2016,35(4):290-295.
[11] Wheeler JA, Harrod K, Liu F,et al. Radioactive seed localization for non-palpable breast lesions in a community hospital setting.Cancer Clin Oncol,2016,5(1):25.
[12] Aima M,Viscariello N,Patton T,et al.Radioactive seed localization for breast lumpectomy-towards optimization.Med Physics,2016,43(6):3407.
[13] Seiler SJ, Mootz AR, Eads ED,et al. Radioactive seed localization:Tips and tricks.Curr Radiol Rep,2016,4(1):3.
[14] Murphy JO, Moo TA,King TA,et al.Radioactive seed localization compared to wire localization in breast-conserving surgery:Initial 6-month experience.Ann Surg Oncol,2013,20(13):4121-4127.
[15] Barentsz MW,van den Bosch MA,Verkooijen HM.Authors'reply:Radioactive seed localization for non-palpable breast cancer.Br J Surg,2013,100(9):1253-1254.
[2] Jakub JW,Gray RJ,Degnim AC,et al.Current status of radioactive seed for localization of non palpable breast lesions.Am J Surg,2009,199(4):522-528.
[3] Theunissen CI,Rust EA,Edens MA,et al.Radioactive seed localization is the preferred technique in non-palpable breast cancer compared with wire-guided localization and radioguided occult lesion localization.Nucl Med Commun,2017,38(5):396-401.
[4] Diego EJ,Soran A,Mcguire KP,et al.Localizing high-risk lesions for excisional breast biopsy:A comparison between radioactive seed localization and wire localization. Ann Surg Oncol,2014,21(10):3268-3272.
[5] Chiu JC,Ajmal S,Zhu X,et al.Radioactive seed localization for nonpalpable breast lesions in a community hospital setting.Am Surg,2014,80(7):675-679.
[6] Hayes MK.Update on preoperative breast localization.Radiol Clin North Am,2017,55(3):591-603.
[7] Morrow M,Van Zee KJ,Solin LJ,et al.Society of surgical oncology-American society for radiation oncology-American society of clinical oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ.Pract Radiat Oncol,2016,23(12):287-295.
[8]赵凯华,李培莹,谭政帅,等.乳腺癌分子亚型的影像特征与保乳手术再切除率的相关性研究.临床肿瘤学杂志,2017,22(7):628-632.
[9] Fung F, Cornacchi SD, Reedijk M,et al. Breast cancer recurrence following radioguided seed localization and standard wire localization of non-palpable invasive and in situ breast cancers:5-year follow-up from a randomized controlled trial.Am J Surg,2017,213(4):798-804.
[10] Hwang E,Kamen J,Sonnenblick EB,et al.Localization of image-detectedbreastabnormalities:Radioactiveseed localization—an alternative to wire localization.J Radiol Nurs,2016,35(4):290-295.
[11] Wheeler JA, Harrod K, Liu F,et al. Radioactive seed localization for non-palpable breast lesions in a community hospital setting.Cancer Clin Oncol,2016,5(1):25.
[12] Aima M,Viscariello N,Patton T,et al.Radioactive seed localization for breast lumpectomy-towards optimization.Med Physics,2016,43(6):3407.
[13] Seiler SJ, Mootz AR, Eads ED,et al. Radioactive seed localization:Tips and tricks.Curr Radiol Rep,2016,4(1):3.
[14] Murphy JO, Moo TA,King TA,et al.Radioactive seed localization compared to wire localization in breast-conserving surgery:Initial 6-month experience.Ann Surg Oncol,2013,20(13):4121-4127.
[15] Barentsz MW,van den Bosch MA,Verkooijen HM.Authors'reply:Radioactive seed localization for non-palpable breast cancer.Br J Surg,2013,100(9):1253-1254.