Ultrasound-guided Percutaneous Radiofrequency-assisted Breast Excision to Remove En-bloc Specimens: Five Years' Experience
LMF Tee, CY Lui, KCH Lau, CY Fong, YCY Chan, M Ying, CM Chan
Hong Kong J Radiol 2014;17:98-108
DOI: 10.12809/hkjr1413208
Objectives: To describe our initial 5-year experience in using the radiofrequency-assisted excision technology in a regional hospital, with an emphasis on the efficacy, techniques, and safety of the procedure.
Methods: Clinical records and operative data of all patients who underwent ultrasound-guided radiofrequency-assisted excision of breast lesions between September 2008 and May 2013 in Kwong Wah Hospital, Hong Kong, were retrospectively reviewed.
Results: A total of 48 consecutive patients and 50 lesions with a mean diameter of 9.2 mm were included. Of the 50 lesions, 27 (54%) were graded Breast Imaging–Reporting and Data System (BI-RADS) 3, 21 (42%) BI-RADS 4, and 2 (4%) BI-RADS 5. The mean operating duration was 6.3 minutes. Final pathology showed 1 ductal carcinoma in-situ, 20 fibroadenomata, 11 fibrocystic changes, 9 papillomata, and 11 miscellaneous benign entities. Complete removal with histological clear margins was achieved in 82% of the lesions. No histological underestimation or recurrence was found on subsequent open surgery or follow-up. The procedure was well-tolerated, with a mean pain score of 1.35 out of 5. One patient (2%) experienced a complication of haematoma formation requiring surgical treatment.
Conclusion: Ultrasound-guided percutaneous radiofrequency-assisted breast excision is a robust diagnostic tool and therapeutic procedure that allows safe, quick, and efficacious en-bloc lesion removal with clear margins. This minimally invasive office procedure is a promising alternative to conventional open excision of benign breast lesions.
中文摘要
超聲引導下經皮射頻輔助乳房切除術行整體標本切除：五年經驗分享
鄭文輝、呂振英、劉仲恒、方俊仁、陳可恩、英偉亮、陳志梅
目的：描述在一所分區醫院中使用射頻輔助切除術的五年初步經驗，集中討論其療效、技術和程序的安全性。
方法：回顧分析在2008年9月至2013年5月期間在香港廣華醫院內接受超聲引導下射頻輔助乳腺腫瘤切除術的病人的臨床紀錄和手術資料。
結果：連續48名患者（50例病變）被納入研究範圍，腫瘤的平均直徑為9.2 mm。50例中，屬於BI-RADS（乳房影像–報告與資料系統）三級的有27例（54%），BI-RADS四級的有21例（42%），BI-RADS五級的有2例（4%）。平均手術時間為6.3分鐘。最終的病理學結果發現有導管原位癌（1例）、乳腺纖維腺瘤（20例）、纖維囊性變（11例）、乳頭狀瘤（9例）和其他良性腫瘤（11例）。徹底切除且組織學上邊緣清晰的病變達82%。其後的外科開放手術或隨訪並無發現組織學的低估或復發。這種技術的病人耐受性良好，平均疼痛分數為1.35（最高分為5分）。一名患者（2%）併發血腫，需進行手術治療。
結論：超聲引導下經皮射頻輔助乳房切除術是一種穩健的診斷工具和治療程序，能安全、快速、有效地將腫瘤整塊切除而切緣清晰。這種微創技術可以作為乳腺良性病變傳統開放式切除術的一個替代方法。