摘要
目的:探讨超声引导下真空辅助活检(vacuum-assisted biopsy,VAB)切除乳腺癌肿块后保乳手术的可行性与安全性。方法:选择2008年1月至2014年12月VAB肿块切除术后行保乳手术治疗的45例浸润性导管癌(invasive ductal carcinoma,IDC)患者(VAB组)。选取同一时期单发、直径小于2cm、肿块切除活检后行保乳手术的147例IDC患者为对照组。分析并比较两组患者的临床病理特征与预后。结果:VAB组肿块均单发、直径<2cm且不可触及,影像学检查误诊为良性。所有VAB手术只行1次穿刺,穿刺点距离肿块的平均距离为(2.52±0.89)cm。中位切割8次,影像学检查示完全切除,平均手术时间(25.4±7.6)min,术中未发生活动性出血。保乳手术距VAB术平均(4.50±0.92)d;局部扩大切除病灶的各个切缘均阴性;无患者发生肿瘤细胞针道或皮肤穿刺点种植;3例残腔残留少量导管原位癌病灶,但无浸润性癌灶。VAB组与对照组平均年龄、年龄构成、肿块直径、肿瘤组织学分级、脉管侵犯、淋巴结分期、前哨淋巴结阳性率、肿瘤分子分型及辅助治疗、腋窝手术差异均无统计学意义。两组间5年无病生存期(disease-free survival,DFS)和5年总生存期(overall survival,OS)差异均无统计学意义。结论:VAB切除不可触及的较小乳腺癌肿块后续行保乳手术安全可行,值得进一步大样本研究。
Objective ： T o explore the feasibility and safety of breast-conservin g su rgery a fte r tum or m ass rem oval byultrasound-guided vacuum -assisted biopsy （ V A B ） . Methods： F o rty -fiv e cases of invasive ductal carcinom a （ ID C ） whounderw ent breast-conservin g surgery after rem oval of tum or m ass by V A B from Jan u ary 2 0 0 8 to D ecem ber 2014 w ere selectedas the V A B group. A total of 147 cases of ID C who underw ent breast-conserving surgery a fte r rem oval of tum or m ass （sin g leand less than 2 cm ） by open excision during th e sam e period w ere selected as th e control group. T h e clinical-pathologicalch aracteristics and survival prognosis of th e tw o groups w ere analyzed and compared. Results： A ll cases in V A B group had asin gle, impalpable tum or m ass less than 2 cm , w hich w as presum ed benign according to imaging exam in ation T h e re w as onlyone puncture in all V A B op erations, and the average distance from the puncture point to the tum or m ass was （ 2 . 52 士0. 8 9 ） cm. T h e m edian incision was 8 tim es？ the imaging exam ination show ed com plete resectio n , th e m ean op eration tim e was（2 5 . 4 士7. 6） m in , and no active bleeding occurred during operation. B re a st conserving surgery was perform ed （4 . 5 0 士0. 9 2 ） da fte r V A B . R esidual cavity, needle tra ct and skin puncture site w ere excised com pletely w ith negative m arg in No tum or celldisplacem ent in needle tra ct or skin site was observed. D uctal carcinom a in situ （D C IS ） rather than invasive carcinom a wasobserved in residual cavity in three cases. T h e re w ere no statistically significant differences betw een tw o groups eith er in m eanag e, age stru ctu re, tum or size, histological grade, vessel invasion, lym ph node stag in g , sentinel lym ph node positive ra te ,m olecular ty p e, adjuvant therapy or axillary su rg ery , or in 5-year D F S or 5-year O S as w ell. Conclusions： B reast-con servin gsurgery after im palpable sm all b reast cancer m ass rem oval by ultrasound-guided V A B is safe and feasible.
作者
陈宏亮
王懋莉
张征
丁昂
C H E N H ong-liang W A N G M ao- li Z H A N G Zheng D IN G Ang(D epartm ent of B re a st Su rg ery , O b stetrics and G ynecology H ospital of Fudan U n iv ersity , Shanghai 2 0 0 0 1 1 , China)
出处
《中国临床医学》
2016年第6期710-714,共5页
Chinese Journal of Clinical Medicine
关键词
真空辅助活检
乳腺癌
保乳手术
超声引导
vacuum -assisted bio p sy； b reast ca n cer； breast-conservin g su rg ery； ultrasound guidance
