数字乳房图解与乳房样本的X射线对手术内边缘评估:一个随机试验
Irina Palimaru Manhoobi1, Trine Tramm2, Søren Redsted3
1Department of Radiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Breast (Edinburgh, Scotland)
|December 8, 2023
概括
数字乳房图解 (DBT) 和X射线显示,乳房保护手术的重新手术率相似. 瘤外的管道癌 in situ (DCIS) 是重新手术的关键风险因素,突出了改善手术内可视化的需要.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 放射学 放射学是一门学科.
- 医疗成像医学成像
背景情况:
- 乳腺节约手术 (BCS) 后所涉及的切除边缘经常需要重新手术,导致患者焦虑增加和美容结果受损.
- 评估手术内边缘评估技术对于提高BCS手术精度和患者满意度至关重要.
研究的目的:
- 为了比较数字乳腺图解合成 (DBT) 与标准X射线在BCS中进行手术内边缘评估的疗效.
- 评估DBT和X射线在预测基因病理边缘状态方面的诊断准确性.
- 为了确定因涉及的利而导致BCS后重新操作的风险因素.
主要方法:
- 这是一项随机的,非盲目的研究,涉及241名侵袭性乳腺癌患者.
- 患者在手术期间使用DBT (n=119) 或X射线 (n=122) 进行了评估.
- 统计分析包括皮尔森的千二测试,费舍尔的精确测试,t测试和后勤/顺序回归.
主要成果:
- 在DBT (16.8%) 和X射线 (19.7%) 组 (p=0.57) 之间没有观察到重复手术率的显著差异.
- 预测基因病理边缘状态的诊断准确性是可比的:DBT的77.5%,X射线的67.3%.
- 重新手术的重大风险因素包括瘤外的DCIS (OR=9.4),高乳房扫描密度 (OR=6.1),不可评估的边缘 (OR=3.8),新辅助化疗 (OR=3.0),和T2瘤大小 (OR=2.6).
结论:
- DBT和X射线在减少重复手术和预测BCS的边际状态方面表现相似.
- 管道癌 in situ (DCIS) 延伸到主要瘤之外,显著增加了重新手术的风险.
- 需要先进的手术内成像技术来增强DCIS的可视化,并在BCS期间实现明确的边缘.
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