保乳手术术中切缘评估技术的现状与进展

doi:10.16139/j.1007-9610.2025.02.14

摘要/Abstract

摘要：

对于保乳手术而言，术中及时而准确的切缘评估是确保手术成功与降低局部复发率的关键。本文首先回顾了目前保乳手术中所使用的切缘评估方法，包括快速病理学检查和标本影像学检查技术。根据技术路径分类，系统地介绍了近年来发展迅速的新兴技术，涵盖高级显微镜、传统影像技术的发展、新兴成像技术以及关注组织生化特性和电特性差异的技术等方向。对上述技术进行总结与横向比较，并结合外科临床需求提出若干评估维度，以期为术中切缘评估技术的优化选择与临床转化提供参考。尽管新技术蓬勃发展，仍需进一步的临床研究和技术改进，不断优化和创新，为病人提供更好的选择。

关键词: 手术切缘, 术中切缘评估, 保乳手术, 乳腺癌

Abstract:

In breast-conserving surgery, timely and accurate intraoperative margin assessment is crucial for ensuring surgical success and reducing local recurrence rates. This review first outlined the current methods for intraoperative margin evaluation, including rapid pathological examination and specimen imaging techniques. According to the technical classification, this review systematically introduced emerging technologies that have advanced significantly in recent years, encompassing advanced microscopy, advancements in conventional imaging technologies, novel imaging technologies, and techniques based on biochemical and electrical property contrasts of tissues. Finally, the review summarized and compared these technologies horizontally, and proposed several assessment dimensions aligned with surgical clinical needs, aiming to support the optimization and clinical translation of intraoperative margin assessment techniques. Despite the vigorous development of new technologies, further clinical research and technical refinement remain necessary to achieve continuous improvement and innovation, ultimately providing better options for the patients.

Key words: Margins, Intraoperative margin assessment, Breast-conserving surgery, Breast Cancer

中图分类号:

R737.9

金小丁综述, 邹强, 金贻婷审校. 保乳手术术中切缘评估技术的现状与进展[J]. 外科理论与实践, 2025, 30(2): 176-182.

JIN Xiaoding, ZOU Qiang, JIN Yiting. Intraoperative margin assessment techniques in breast-conserving surgery: current status and advances[J]. Journal of Surgery Concepts & Practice, 2025, 30(2): 176-182.

图/表 1

参考文献 54

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Techniques		in vivo applicability	Surface condition tolerance	Pathological typing capability	Non-destructive sample handling
Frozen section analysis			√	√
Advanced microscopy	Nonlinear microscopy			√	√，enabled by pretreatment
Advanced microscopy	Confocal laser microscopy	√		√	√，enabled by pretreatment
Advancements in conventional imaging technologies	Micro-computed tomography		√		√
	Mobile magnetic resonance imaging system		√		√
	Breast positron emission tomography using novel scintillator		√		√
	Cerenkov luminescence imaging		√		√
Optical imaging techniques exploiting surface and structural properties	Optical coherence tomography	√			√
	Hyperspectral imaging	√			√
	Terahertz pulsed imaging				√
	Photoacoustic imaging	√			√
Fluorescence imaging		√			√，enabled by pretreatment
Techniques based on biochemical property contrast of tissues	Raman spectroscopy	√			√
	Diffuse reflectance spectroscopy	√			√
	Rapid evaporative ionization mass spectrometry	√	√		√
	Desorption electrospray ionization mass spectrometry	√			√
	Optical fiber sensing	√			√
Techniques based on electrical property contrast of tissues	Radiofrequency spectroscopy	√			√
Techniques based on electrical property contrast of tissues	Bioimpedance spectroscopy	√			√
Flow cytometry			√