【摘要】 目的 探讨超声引导下导丝定位在不可触及的乳腺病灶切除中的应用价值。 方法 对2005年1月－2010年9月127例女性患者的137个乳腺病灶（临床扪诊均为阴性），在超声引导下进行导丝定位，后进行外科切除活检，并对相关资料进行回顾性分析。 结果 137个病灶的组织学结果中，良性病灶101个（73.7%）、高风险病灶27个（19.7%）和癌9个（6.6%）。9个癌中3个为导管原位癌，6个为浸润性导管癌（大小11～19 mm，平均14.2 mm）。超声引导下导丝定位的时间为3～15 min，平均6 min；无血肿、导丝脱落及折断等并发症发生。外科手术切除时间20～40 min，平均30 min。 结论 超声引导下进行导丝定位安全、迅速，能协助外科手术进行准确的活检和切除。【Abstract】 Objective To determine the application value of ultrasound-guided wire localization in surgical excision of non-palpable breast lesions. Methods Between January 2005 and September 2010, 127 women with 137 non-palpable breast lesions underwent surgical excision at West China Hospital. Palpation results for all the lesions were negative. Wire localization guided by ultrasound was performed before operation and biopsy. Related imaging studies and medical records were reviewed retrospectively. Results Histological findings showed there were 101 benign lesions (73.7%), 27 high-risk lesions (19.7%), and 9 carcinomas (6.6%). Among the 9 carcinomas, 3 were ductal carcinoma in situ, and 6 were infiltrating carcinoma (with their size ranged from 11 to 19 mm averaging at 14.2 mm). The time of performing ultrasound-guided wire localization was from 3 to 15 minutes averaging at 6. No complications like hematoma, wire fragments, and wire breakage occurred in all cases. The surgical excision time ranged from 20 to 40 minutes averaging at 30. Conclusions Ultrasound-guided wire localization can be performed quickly and safely for the cases of non-palpable breast lesions. It is useful in assisting surgical excision and biopsy.
ObjectiveTo compare the effectiveness of sequential method pure single-port lumpectomy-breast conserving surgery (SMPSL-BCS) in treating early-stage breast cancer patients with tumors in different quadrants. Methods A retrospective analysis was conducted on 200 early-stage breast cancer female patients admitted between January 2023 and December 2023. According to the quadrant where the tumor was located, the patients were allocated into the upper outer quadrant group (UO group), lower outer quadrant group (LO group), upper inner quadrant group (UI group), and lower inner quadrant group (LI group), with 50 cases in each group. There was no significant difference (P>0.05) in the baseline data, including age, body mass index, smoking history, marital status, comorbidities, affected breast side, maximum tumor diameter on ultrasound, maximum pathological tumor diameter, clinical tumor stage, molecular subtype, and disease duration. The operation time, intraoperative blood loss, postoperative drainage volume, and extubation time were recorded and compared between groups. Additionally, the occurrence of early-stage complications (1-3 months after operation; including subcutaneous fluid accumulation, incision infection, superficial skin burns) and late-stage complications (>3 months after operation; including pectoralis major muscle adhesion, changes in breast appearance and shape, sensory discomfort) were assessed. At 6 months after operation, the cosmetic outcome of breast-conserving surgery was rated for all groups. Results The UO group had the shortest operation time, followed by the UI group, LO group, and LI group, showing significant differences between groups (P<0.05). The UO group had the least intraoperative blood loss, followed by the LO group, UI group, and LI group; except for the difference between UO group and LO group, which was not significant (P>0.05), the differences between the other groups were significant (P<0.05). The UO group had the least postoperative drainage volume, followed by the LO group, UI group, and LI group; except for the difference between LO group and UI group, which was not significant (P>0.05), the differences between the other groups were significant (P<0.05). The extubation time of the LI group was significantly longer than that of the other groups (P<0.05). All patients were followed up 4-12 months, with an average of 8 months. And 193 patients were followed up more than 6 months, including 48 patients in UO group, 47 in LO group, 49 in UI group, and 49 in LI group. In the early-stage period, the LI group had a higher incidence of subcutaneous fluid accumulation after tube removal compared to the UO group and LO group (P<0.05), while there was no significant difference in the incidences of other early complications between groups (P>0.05). In the late-stage period, the LI group had significantly higher incidences of pectoralis major muscle adhesion and changes in breast appearance and shape than UO group and LO group (P<0.05), and a significantly higher incidence of sensory discomfort than UO group (P<0.05). There was no significant difference in the incidences of other late-stage complications between groups (P>0.05). At 6 months after operation, the cosmetic outcomes of breast-conserving surgery were significantly better in UO group, LO group, and UI group than in LI group (P<0.05); there was no significant difference between the other groups (P>0.05). Conclusion In the treatment of early-stage breast cancer using SMPSL-BCS, patients with tumors located in the upper outer quadrant show the best effectiveness. The effectivenesses are similar for patients with tumors in the lower outer and upper inner quadrants. However, patients with tumors in the lower inner quadrant do not experience significant advantages. Therefore, it is recommended that SMPSL-BCS should not be the first-choice surgical method for patients with tumors in the lower inner quadrant.