Intraoperative ultrasound in conservative surgery for non-palpable breast cancer after neoadjuvant chemotherapy

被引：28

作者：

Ramos, M. ^{[1
]}

Diez, J. C. ^{[2
]}

Ramos, T. ^{[1
]}

Ruano, R. ^{[3
]}

Sancho, M. ^{[4
]}

Gonzalez-Orus, J. M. ^{[1
]}

机构：

[1] Salamanca Univ Hosp, Breast Surg Unit, Dept Surg, Salamanca 37007, Spain

[2] Salamanca Univ Hosp, Breast Unit, Dept Radiol, Salamanca, Spain

[3] Salamanca Univ Hosp, Breast Unit, Dept Nucl Med, Salamanca, Spain

[4] Salamanca Univ Hosp, Breast Unit, Dept Pathol, Salamanca, Spain

来源：

INTERNATIONAL JOURNAL OF SURGERY | 2014年 / 12卷 / 06期

关键词：

Breast cancer; Neoadjuvant chemotherapy; Non-palpable; Complete clinical response; Intraoperative ultrasound localization; Re-excision rate; CONSERVING SURGERY; TUMOR RESPONSE; PATHOLOGICAL RESPONSE; SPECIMEN ULTRASOUND; ACCURACY; LOCALIZATION; MAMMOGRAPHY; MARGINS; ULTRASONOGRAPHY; CARCINOMA;

D O I：

10.1016/j.ijsu.2014.04.003

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Aims: A complete clinical response after neoadjuvant chemotherapy (NACT) in breast cancer patients hinders the localization of the residual lesion and the removal of a minimum amount of breast tissue. The aim of the present work is to report our single-centre experience with intraoperative ultrasound-guided (IOUS) excision performed by surgeons in these patients. Patients and methods: From January 2008 to December 2012, IOUS excisions were performed on 58 patients with a previous intralesional ultrasound-detectable metallic marker and non-palpable breast cancer after NACT. The specimen margins were estimated by ultrasonography and macroscopic pathologic examination. Successful lesion removal, specimen weight, and analysis of the results as regards margins were evaluated, and the need for breast-conserving re-excision and mastectomy was considered. Results: After NACT the average ultrasound/mammography and MRI diameters were 11.7 mm (0-30) and 9.1 mm (0-40) respectively. In all cases, the residual lesion or tissue around the marker was removed. The average weight of the specimens was 26.4 g (6-84), being lower in cases of complete response according to ultrasound (p < 0.05). In 4 patients (6.8%), breast-conserving re-excision was carried out, and in 3 patients (5.2%) a secondary mastectomy was performed, two of which had invasive lobular carcinoma. Conclusions: The emplacement of a readily echodetectable metal marker before NACT makes IOUS excision feasible in an increasing number of complete clinical responses, with the excision of small amounts of breast tissue and a high percentage of conservative breast surgery. This technique requires surgeons to be trained, but has the advantage of a reduced use of other hospital services, better planning of operating theatres, and less discomfort for patients, which means that it is attractive and indeed recommendable. (C) 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

引用

页码：572 / 577

页数：6

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