放射性粒子定位引导在乳腺隐匿性病变保留乳房治疗临床应用

Radioactive seed localization guided excision of non-palpable breast lesions in breast-conserving surgery

目的隐匿性乳腺病变最常用的定位方法是金属丝定位,但患者舒适度差、并发症多,且易移位,探索新方法来弥补这种缺陷尤为重要。本研究旨在探讨放射性粒子定位(radioactive seed localization,RSL)引导切除隐匿性乳腺病变在保留乳房手术中的应用价值。方法收集2016-01-03-2019-01-03山东省肿瘤医院就诊的135例女性隐匿性乳腺病变患者资料,共143处病变(钙化119处,结构扭曲10处,新辅助化疗后肿块消失仅残留钙化或mark夹14处),于术前5d内行放射性粒子定位。将手术切除的标本送X射线摄影,并与术前X射线片比较病变形态和钙化范围;确定病变与放射性粒子的空间位置。统计放射性粒子定位的准确率;根据首次切除标本的快速病理结果确定首次切缘阴性率,同时统计定位过程中相关并发症发生情况。结果143例患者放射性粒子和病变均在切除标本中,定位准确率为100.00%(143/143),乳腺X射线摄影示病灶完整切除率为100.00%(143/143),首次切缘阴性率为90.21%(129/143)。放射性粒子定位后患者迷走神经反应、低血糖等相关并发症发生率为0。结论放射性粒子可准确定位隐匿性乳腺病变并引导切除,定位的时机不受手术时间影响,首次切缘阴性率高,相关并发症少,在保留乳房手术中引导切除隐匿性乳腺病变具有重要的应用价值。

OBJECTIVE Wire localization is the most common localization method for non-palpable breast lesions,but it is uncomfort for patients,and has too many complications and easy to shift.It is important to explore new methods to make up for this defect.The purpose of this paper is to explore the application value and the efficacy of radioactive seed localization(RSL)for intraoperative localization of non-palpable breast lesions before breast-conserving therapy.METHODS Totally 135 women with non-palpable breast lesions underwent breast-conserving surgery treated by Shandong Cancer Hospital and Institute from January 3,2016 to January 3,2019 were collected.There were 143 lesions(119 calcification,10 architectural distortion,14 residual calcification or mark clip after neoadjuvant chemotherapy).Radioactive seed localization was performed within 5 days before the surgery.Pathological examination were performed after the surgery,and the specimens were taken to mammography,lesion morphology and calcification range were compared with preoperative radiographs.The precision rate of location,the rates of tumor-free margin as well as the localization-related complications were recorded.RESULTS The radioactive seed of 143 lesions were all in the resected specimens.All lesions were located precisely and removed completely(143/143).The first tumor-free margin rate of RSL was 90.21%(129/143),and no localization-related complication occurred in RLS group.CONCLUSIONS RSL can be used for accurate location and guided resection of non-palpable breast lesions,the positioning of RSL is not affected by the operation time.RSL also has the higher tumor-free margin rate and lower re-excision rate.