Background: The aim of the implementation of preoperative marking procedures in non-palpable breast cancer is to obtain a successful excision of the intended lesion with tumor-free resection margins while removing as little as possible of the surrounding healthy breast tissue to better preserve cosmetic integrity. Based on the intraoperative X-ray of the tumor specimen, intraoperative widening of selected surgical resection margins (IWSM) can be performed to decrease the positive margin rate. This study aims to evaluate the role of IWSM in breast-conserving surgery. Methods: All patients undergoing guidewire localized conservative surgery for non-palpable breast cancers were considered for the study. Patients, tumor characteristics, and pathological findings were collected. Tumor specimens undergoing intraoperative X-ray were considered for the analysis. The number of IWSM specimens, the IWSM specimens containing tumor cells at final histology, and the volume of IWSM specimens were calculated. Results: Data from 771 tumorectomies for non-palpable breast cancer performed between 2017 and 2023 at the Centro di Senologia della Svizzera Italiana (CSSI) were collected. A total of 751 tumorectomies with intraoperative X-ray assessment of the margin’s status were included. In 461/751 cases (61.4%), at least one IWSM specimen was obtained. At the final histopathology, in 354/461 IWSM specimens (76.8%), no tumor cells were reported, while they were reported in 107/461 (23.2%). Of these, 89/107 (83.2%) had overall negative margins, while 18/107 (16.8%) presented involved margins at the final histopathology. In 323/461 (70.1%) IWSM specimens, the pathological report provided three dimensions useful for volume calculation. The mean volume of these specimens was 9 ± 15 cm3. Conclusions: IWSM can help increase the efficacy of tumorectomies for non-palpable breast cancer lesions. However, in the majority of cases, healthy breast tissue is removed as well. Tumor and patient characteristics may help in the selection of cases for which IWSM reduces the positive margin rate and the number of unnecessary procedures.
背景：对不可触及的乳腺癌实施术前标记程序的目的在于，在尽可能保留周围健康乳腺组织以维持美观完整性的前提下，成功切除目标病灶并获得阴性切缘。基于术中肿瘤标本的X线检查，可对选定的手术切缘进行术中扩大切除（IWSM），以降低阳性切缘率。本研究旨在评估IWSM在保乳手术中的作用。方法：研究纳入所有因不可触及乳腺癌接受导丝定位保乳手术的患者。收集患者资料、肿瘤特征及病理结果。分析涵盖接受术中X线检查的肿瘤标本。统计IWSM标本数量、最终组织学检查显示含肿瘤细胞的IWSM标本数量及IWSM标本体积。结果：收集了2017年至2023年间在意大利瑞士乳腺中心（CSSI）进行的771例不可触及乳腺癌肿瘤切除术数据。其中751例肿瘤切除术包含术中X线切缘状态评估。在461/751例（61.4%）中至少获取了一个IWSM标本。最终组织病理学显示，354/461例（76.8%）IWSM标本未见肿瘤细胞，而107/461例（23.2%）报告存在肿瘤细胞。其中89/107例（83.2%）总体切缘为阴性，18/107例（16.8%）最终组织病理学显示切缘受累。在323/461例（70.1%）IWSM标本中，病理报告提供了可用于体积计算的三维数据。这些标本的平均体积为9±15 cm³。结论：IWSM有助于提高不可触及乳腺癌病灶肿瘤切除术的疗效。然而，在多数情况下，健康乳腺组织也被一并切除。肿瘤特征和患者特点可能有助于筛选适合IWSM的病例，从而降低阳性切缘率并减少不必要的手术操作。
肿瘤(癌症)患者之家