保乳手术切缘评估及术中乳腺X线摄片的临床应用

doi:10.16139/j.1007-9610.2020.06.021

摘要/Abstract

中图分类号:

R737.9

Andriani（李美珠）, 吴佳毅(综述), 朱丽(审校). 保乳手术切缘评估及术中乳腺X线摄片的临床应用[J]. 外科理论与实践, 2020, 25(06): 537-540.

Andriani Lisa, WU Jiayi, ZHU Li. Clinical application of intraoperative specimen mammography in evalution of margin during breast conserving surgery[J]. Journal of Surgery Concepts & Practice, 2020, 25(06): 537-540.

图/表 2

图1

表1

术中乳腺X线摄片在保乳手术临床应用的相关研究

文献	出版年	术中乳腺X线摄片组(n)	无术中乳腺X线摄片组(n)	临床病理特征	结果
Bathla等^[18]	2011	102	/	①均为术前未触及病灶;②79.4% 为浸润性导管癌;③肿瘤直径平均1.6 cm	①73例（71.6%）术中乳腺X线摄片评估切除范围足够,其中17例（23.2%）术后病理结果为切缘阳性;余29例（28.4%）术中乳腺X线摄片评估切除范围不足,予以补充切除,其中2例（6.9%）石蜡病理切缘阳性;②19例（18.6%）切缘阳性中,其中15例（14.7%）需行再次保乳手术;③术中乳腺X线摄片使84.3%病人首次手术中成功完成保乳手术
Layfield等^[23]	2012	104	107	①均为术前触及病灶;②84.5%为浸润性导管癌	①术中乳腺X线摄片显著降低切除标本的大小（110.2 g比70.3 g,P=0.001）;②术中乳腺X线摄片对于降低切缘阳性率及再切除率差异无统计学意义（29.8%比24.2%,P=0.60;23.4%比27.4%,P=0.65）
Kim等^[19]	2013	96	105	①均为术前未触及病灶;②63%为浸润性导管癌;③69%肿块直径≤2 cm ;④51%乳腺X线检查表现为钙化	①术中乳腺X线摄片更好地降低切缘阳性（12.7%比26.6%,P=0.012）及近切缘阳性率（25.3%比37.2%,P=0.028）;②再切除率两组差异无统计学意义（14.6%比17.1%, P=0.641）
Ihrai等^[20]	2014	155	/	①77例为术前未触及病灶;②74.7%为浸润性导管癌	①16例术中乳腺X线摄片后行补充切缘切除,其中10例（6.5%）石蜡病理检查切缘阳性;②术中乳腺X线摄片降低3.8% 切缘阳性率
Majdak- Paredes等^[21]	2015	98	/	①70%为术前未触及病灶;②72.4%为浸润性导管癌	仅3例（3%）切缘阳性
Hisada等^[22]	2016	174	/	①24%为术前未触及肿块;②70%为浸润性导管癌;③56%肿块直径≤2 cm;④仅29%病人乳腺X线表现为钙化	①24例（13.8%）术中乳腺X线摄片评估后行再切除;②150例（86.2%）未再切除;③切缘阳性率在两组病例中相似（20.8%比20.0%)

表1

参考文献 23

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保乳手术切缘评估及术中乳腺X线摄片的临床应用

Clinical application of intraoperative specimen mammography in evalution of margin during breast conserving surgery

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