背景乳腺癌仍然是影响全球女性的最常见恶性肿瘤之一。对疾病负担有很大贡献。新辅助化疗(NAC)的出现彻底改变了局部晚期乳腺癌的治疗方法,允许肿瘤降级,并使保乳手术(BCS)可行。NAC后肿瘤床的准确定位对于成功手术切除残留疾病至关重要。虽然传统的单组织标记物放置是有效的,最近的进展表明,多种标记物可能通过全面描绘整个肿瘤区域而提供优越的定位.这项研究旨在比较接受NAC的乳腺恶性肿瘤患者中单个组织标记物放置与多个组织标记物放置的有效性。材料和方法在Saveetha医学院的放射诊断学系进行了18个月的前瞻性研究,包括10名诊断为乳腺癌的患者,通过方便抽样选择。纳入标准涉及通过乳房X线照相术诊断为乳腺癌的患者,超声检查,和组织学确认,参考NAC之前的剪辑位置。排除标准是患者不愿参加。该程序包括在USG引导下使用14/16号同轴引导针在肿瘤内放置一到两个手术夹,与更大或多个肿瘤的额外的夹子。数据收集包括程序前USG,术后乳房X线照相术(MG1),术前乳房X线照相术(MG2)/USG,和大体标本组织病理学检查/标本乳房X线照相术。统计学分析人口统计数据,削波分布,受体状态,本地化方法,手术结果,手术诊断,相关分析进行统计学分析。平均年龄,标准偏差,计算p值,以确定单个和多个夹组之间差异的显著性.结果该研究包括10例患者,平均年龄为52.5岁。其中,五个(50%)有一个剪辑,两个(20%)有四个夹子。从剪裁到第二次乳房X线照片(MG2)的平均时间为106.3天,从剪裁到手术是111.0天,多夹患者随访时间更长。6例(60%)患者雌激素受体(ER)阳性,6例(60%)人表皮生长因子受体2(HER2)阴性。单个和多个剪辑组之间的定位方法相似。然而,多夹患者倾向于接受更广泛的手术,如改良根治术(MRM)。影像学反应显示单夹患者术前无超声病变,而多个夹片患者的诊断不一致较高(10例(100%)),提示多个夹片提供更好的肿瘤定位,但与复杂性增加和随访时间延长有关.结论多夹患者随访时间明显延长,反映更复杂的临床情况。尽管受体状态分布没有显着差异,多个夹子患者需要更广泛的手术,强调需要量身定制的手术计划。该研究强调了在临床决策中考虑剪辑数量的重要性。未来的研究应该集中在更大的,前瞻性研究验证这些发现并探索潜在机制。
Background Breast cancer remains one of the most common malignancies affecting women globally, contributing significantly to the disease burden. The advent of neoadjuvant chemotherapy (NAC) has revolutionized the treatment for locally advanced breast cancer, allowing tumors to be downstaged and making breast-conserving surgery (BCS) feasible. Accurate localization of the tumor bed post-NAC is crucial for successful surgical removal of residual disease. While traditional single tissue marker placement has been effective, recent advances suggest multiple markers might provide superior localization by comprehensively delineating the entire tumor area. This study aims to compare the effectiveness of single versus multiple tissue marker placements in breast malignancy patients undergoing NAC. Materials and methods A prospective study was conducted in the Department of Radio-diagnosis at Saveetha Medical College over 18 months, including 10 patients diagnosed with breast carcinoma, selected through convenience sampling. Inclusion criteria involved patients diagnosed with breast cancer via mammography, sonography, and histological confirmation, referred for clip placement before NAC. Exclusion criteria were patients unwilling to participate. The procedure involved placing one to two surgical clips within the tumor using a 14/16-gauge coaxial guiding needle under USG guidance, with additional clips for larger or multiple tumors. Data collection included pre-procedural USG, post-procedural mammography (MG1), pre-operative mammography (MG2)/USG, and gross specimen histopathological examination/specimen mammography. Statistical analysis Demographic data, clipping distribution, receptor status, localization methods, surgical outcomes, operation diagnoses, and correlation analysis were statistically analyzed. Mean age, standard deviation, and p-values were calculated to determine the significance of differences between single and multiple clip groups. Results The study included 10 patients with a mean age of 52.5 years. Of these, five (50%) had a single clip, and two (20%) had four clips. The average time from clipping to the second mammogram (MG2) was 106.3 days, and from clipping to operation was 111.0 days, with longer follow-up times for multiple clip patients. Six (60%) of the patients were estrogen receptor (ER) positive, and six (60%) were human epidermal growth factor receptor 2 (HER2) negative. Localization methods were similar between single and multiple clip groups. However, multiple clip patients tended to undergo more extensive surgeries like modified radical mastectomy (MRM). Imaging responses showed no preoperative ultrasound lesions in single clip patients, while multiple clip patients had higher inconsistent diagnoses (10 (100%)) suggesting that multiple clips provide better tumor localization but are linked to increased complexity and longer follow-up times. Conclusion Patients with multiple clips experienced significantly longer follow-up times, reflecting more complex clinical scenarios. Despite no significant differences in receptor status distributions, multiple clip patients required more extensive surgeries, emphasizing the need for tailored surgical planning. The study underscores the importance of considering the number of clips in clinical decision-making. Future research should focus on larger, prospective studies to validate these findings and explore underlying mechanisms.