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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2019, Vol. 13 ›› Issue (01) : 30 -36. doi: 10.3877/cma.j.issn.1674-0807.2019.01.005

所属专题： 文献；

论著

乳腺不可触及病灶的放射导向定位与传统导丝定位对比的Meta分析
徐新建1, 吴娟2, 朱芮2, 李静静2, 季文斌2, 刘强3,†()   
  1. 1. 214400　江苏省江阴市人民医院介入放射科
    2. 317000　温州医科大学附属台州医院放射科
    3. 250000　济南，山东大学附属山东医学影像研究所
  • 收稿日期:2017-06-04 出版日期:2019-02-01
  • 通信作者: 刘强

Radioguided versus wire-guided localization for non-palpable breast lesions: a meta-analysis

Xinjian Xu1, Juan Wu2, Rui Zhu2, Jingjing Li2, Wenbin Ji2, Qiang Liu3,†()   

  1. 1. Department of Interventional Radiology, Jiangyin People’s Hospital, Jiangyin 214400, China
    2. Department of Radiology, Taizhou Hospital of Wenzhou Medical University, Taizhou 317000, China
    3. Department of Radiology, Shandong Medical Imaging Research Institute Affiliated to Shandong University, Jinan 250000, China
  • Received:2017-06-04 Published:2019-02-01
  • Corresponding author: Qiang Liu
  • About author:
    Corresponding author: Liu Qiang, Email:
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引用本文：

徐新建, 吴娟, 朱芮, 李静静, 季文斌, 刘强. 乳腺不可触及病灶的放射导向定位与传统导丝定位对比的Meta分析[J]. 中华乳腺病杂志(电子版), 2019, 13(01): 30-36.

Xinjian Xu, Juan Wu, Rui Zhu, Jingjing Li, Wenbin Ji, Qiang Liu. Radioguided versus wire-guided localization for non-palpable breast lesions: a meta-analysis[J]. Chinese Journal of Breast Disease(Electronic Edition), 2019, 13(01): 30-36.

目的

比较放射导向定位技术，包括导向放射隐匿性病灶定位(ROLL)和放射性粒子定位(RSL)技术与导丝定位(WGL)的临床效果，评估放射导向定位技术在不可触及的乳腺病灶(NPBL)检测中的应用价值。

方法

检索PubMed、Embase、Cochrane、万方、中国知网、维普数据库，收集截至2017年4月关于放射导向定位与WGL对比的随机对照临床试验。由2名研究者独立完成文献筛选、数据提取，运用Cochrane协作网系统评价手册推荐的偏倚风险评价工具进行文献质量评价。采用风险比(RR)和95%置信区间(CI)评价二分类数据的差异，采用均数差(MD)和95%CI评价连续性数据的差异，使用RevMan 5.3软件进行Meta分析。

结果

共纳入14项随机对照研究，纳入患者2 311例，其中，ROLL组562例，RSL组614例，WGL组1 135例。ROLL组与WGL组的定位并发症发生率(RR＝0.53，95%CI：0.24～1.18，P＝0.120)、病灶成功切除率(RR＝1.01，95%CI：0.99～1.02，P＝0.240)、切缘阳性率(RR＝0.88，95%CI：0.68～1.13，P＝0.310)、术中再切除率(RR＝1.07，95%CI：0.71～1.61，P＝0.750)、再次手术率(RR＝0.54，95%CI：0.23～1.25，P＝0.150)，术后并发症发生率(RR＝0.88，95%CI：0.56～1.40，P＝0.590)及切除标本体积(MD＝－2.11，95%CI：－8.39～4.16, P＝0.510)比较，差异均无统计学意义。RSL组与WGL组的定位并发症发生率(RR＝1.02，95%CI：0.21～5.08，P＝0.980)、切缘阳性率(RR＝0.84，95%CI：0.65～1.09，P＝0.190)、再次手术率(RR＝0.78，95%CI：0.55～1.11, P＝0.170)及术后并发症发生率(RR＝1.34, 95%CI：0.81～2.22, P＝0.260)比较，差异也均无统计学意义。

结论

在NPBL的定位技术中，放射导向定位技术具有与传统导丝定位技术相似的定位效果及广泛的临床应用前景。

关键词: 乳腺肿瘤, 触诊, 放射外科手术, 放射学, Meta分析
Objective

To compare the therapeutic outcome of radioguided occult lesion localization(ROLL)and radioactive seed localization (RSL)with wire-guided localization (WGL) in patients with non-palpable breast lesions (NPBL).

Methods

The PubMed, Embase, Cochrane, CNKI, Wanfang and VIP databases were searched for randomized control studies which compared ROLL/RSL with WGL from the earliest available date up to April 2017. Two researchers independently completed literature retrieval and data extraction, and evaluated the quality of the studies based on Cochrane handbook. Risk ratio(RR)and mean difference(MD)with 95% confidence interval(CI)were pooled for dichotomous and continuous variables, respectively. RevMan 5.3 software was adopted for a meta-analysis.

Results

Fourteen randomized controlled trials(RCT) were eligible, involving a total of 2 311 patients(ROLL: n=562, RSL: n=614, WGL: n=1 135). There was no significant difference in localization-related complication rate (RR=0.53, 95%CI: 0.24-1.18, P=0.120), successful excision rate (RR=1.01, 95%CI: 0.99-1.02, P=0.240), positive margin rate (RR=0.88, 95%CI: 0.68-1.13, P=0.310), intra-operative re-excision rate (RR=1.07, 95%CI: 0.71-1.61, P=0.750), re-operation rate (RR=0.54, 95%CI: 0.23-1.25, P=0.150), postoperative complication rate (RR=0.88, 95%CI: 0.56-1.40, P=0.590) and specimen volume (MD=-2.11, 95%CI: -8.39-4.16, P=0.510)between ROLL group and WGL group. No significant difference was observed in localization-related complication rate (RR=1.02, 95%CI: 0.21-5.08, P=0.980), positive margin rate (RR=0.84, 95%CI: 0.65-1.09, P=0.190), re-operation rate (RR=0.78, 95%CI: 0.55-1.11, P=0.170) and postoperative complication rate (RR=1.34, 95%CI: 0.81-2.22, P=0.260) between RSL group and WGL group.

Conclusion

With similar effect to WGL, ROLL and RSL are feasible for the localization of non-palpable breast lesions in clinic.

Key words: Breast neoplasms, Palpation, Radiosurgery, Radiology, Meta-analysis
表1 纳入文献的基本情况及基线特征资料
研究者 纳入标准 排除标准 分组 例数 年龄(岁) 病理类型 定位导向方法
良性疾病 导管原位癌 侵袭性乳腺癌 超声 立体
Ocal等[3] 触诊阴性乳腺病变需切除活组织检查 NR ROLL 56 45 (25～61) 44 6 6 31 25
WGL 52 47 (34～72) 38 7 7 21 31
Medina-franco等[4] 女性，年龄≥18岁；触诊阴性乳腺病变需病理诊断 白蛋白过敏；弥漫微小钙化灶或多中心病变；接受手术切除 ROLL 50 55.8±9.3 NR NR 9 9 41
WGL 50 55.3±10.2 NR NR 8 11 39
Alikhassi等[9] 触诊阴性乳腺病变经穿刺证实为良性，需BCS；患者焦虑和/或影像检查与病理结果不一致 NR ROLL 30 NR 30 0 0 NR NR
WGL 30 NR 30 0 0 NR NR
Duarte等[10] 女性，年龄≥18岁；触诊阴性乳腺病变；BI-RADS 3～5级 弥漫微小钙化灶或多中心病变；先前接受手术或切除活组织检查 ROLL 64 57.3±10.7 52 5 7 20 44
WGL 65 56.9±9.6 51 9 5 28 37
Kanat等[11] 触诊阴性乳腺病变(≤2 cm)；BI-RADS 3～5级 妊娠期；哺乳期 ROLL 25 47.6±10.6 16 0 9 13 12
WGL 11 53.3±10.3 4 0 7 6 5
Mariscal等[12] 触诊阴性乳腺癌经穿刺活组织检查证实，需BCS及SNB 先接受切除活组织检查或曾接受新辅助化疗；肿瘤进展或多发肿瘤 ROLL 66 57.5±10.5 0 10 56 45 21
WGL 68 56.4±11.7 0 14 54 37 31
Moreno等[13] 怀疑乳腺肿物或微小簇状钙化灶需诊断性切除 NR ROLL 61 50.7(32.0～76.0) 51 8 2 NR NR
WGL 59 49.9(35.0～77.0) 43 10 6 NR NR
Postma等[14] 女性，年龄≥18岁；细针穿刺证实隐匿性乳腺癌，需BCS及SNB 妊娠期；哺乳期；多发疾病；原位癌；乳腺假体 ROLL 162 60.5±7.7 0 73a 90a 150a 13a
WGL 152 61.1±9.7 0 75a 78a 146a 7a
Rampaul等[15] 触诊阴性乳腺病变需治疗或诊断性切除 NR ROLL 48 NR 9 13 26 24 24
WGL 47 NR 8 12 27 21 26
Bloomquist等[16] 女性，年龄≥18岁；触诊阴性乳腺癌或导管原位癌经穿刺活组织检查证实，需BCS NR RSL 70 67 0 24 46 NR NR
WGL 55 64 0 16 39 NR NR
Fung等[17] 女性，年龄≥18岁；触诊阴性乳腺癌或导管原位癌经穿刺活组织检查证实，需BCS 男性；妊娠期；多中心病变；局部进展病变；手术禁忌证 RSL 146 60.8±10.5 0 29 117 NR NR
WGL 152 59.9±9.5 0 23 129 NR NR
Gray等[18] 触诊阴性乳腺病变 NR RSL 51 NR 16 4 31 NR NR
WGL 46 NR 20 5 21 NR NR
Langhans等[19] 女性，年龄≥18岁；触诊阴性乳腺癌或导管原位癌经穿刺活组织检查证实，需BCS 良性病变；多中心病变；先前接受切除活组织检查，曾接受辅助化疗 RSL 195 63(57～68) 0 1 194 NR NR
WGL 195 64(57～69) 0 10 185 NR NR
Lovrics等[20] 女性，年龄≥18岁；触诊阴性乳腺癌或导管原位癌经穿刺活组织检查证实，需BCS 妊娠期；多中心病变；局部进展；小叶原位癌 RSL 152 60.9±9.5 0 30 122 107 45
WGL 153 59.9±10.4 0 24 129 106 47
图1 文献检索流程图
表2 Cochrane偏倚风险评估工具对14篇纳入文献的质量评价结果(篇)
评价项目及偏倚 偏倚风险低 偏倚风险高 不清楚
随机顺序的产生(选择性偏倚) 9 0 5
随机方案的分配隐藏(选择性偏倚) 7 5 2
研究对象及干预实施者采取盲法(实施偏倚) 0 14 0
结果测评者采取盲法(测量偏倚) 0 14 0
结局指标数据的完整性(失访偏倚) 13 0 1
选择性报道研究结果(报道偏倚) 8 0 6
其他方面的偏倚 0 0 14
图2 ROLL组与WGL组定位并发症发生率的森林图和异质性分析
图3 ROLL组与WGL组切缘阳性率的森林图和异质性分析
图4 ROLL组与WGL组再次手术率的森林图和异质性分析
[1]
Lovrics PJ, Cornacchi SD, Farrokhyar F, et al. The relationship between surgical factors and margin status after breast-conservation surgery for early stage breast cancer[J]. Am J Surg, 2009，197(6):740-746.
[2]
Monti S, Galimberti V, Trifiro G, et al. Occult breast lesion localization plus sentinel node biopsy (SNOLL): experience with 959 patients at the European Institute of Oncology[J]. Ann Surg Oncol, 2007，14(10):2928-2931.
[3]
Ocal K, Dag A, Turkmenoglu O, et al. Radioguided occult lesion localization versus wire-guided localization for non-palpable breast lesions: randomized controlled trial[J]. Clinics (Sao Paulo), 2011，66(6):1003-1007.
[4]
Medina-franco H, Abarca-pérez L, García-alvarez MN, et al. Radioguided occult lesion localization (ROLL) versus wire-guided lumpectomy for non-palpable breast lesions: a randomized prospective evaluation[J]. J Surg Oncol, 2008, 97(2):108-111.
[5]
Bronstein AD, Kilcoyne RF, Moe RE. Complications of needle localization of foreign bodies and nonpalpable breast lesions[J]. Arch Surg, 1988, 123(6):775-779.
[6]
Luini A, Zurrida S, Paganelli G, et al. Comparison of radioguided excision with wire localization of occult breast lesions[J]. Br J Surg, 1999, 86(4):522-525.
[7]
Murphy JO, Moo TA, King TA, et al. Radioactive seed localization compared to wire localization in breast-conserving surgery: initial 6-month experience[J]. Ann Surg Oncol, 2013, 20(13):4121-4127.
[8]
Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials[J]. BMJ, 2011, 343:d5928.
[9]
Alikhassi A, Saeed F, Abbasi M, et al. Applicability of radioguided occult lesion localization for nonpalpable benign breast besions, bomparison with wire localization, a clinical trial[J]. Asian Pac J Cancer Prev, 2016, 17(7):3185-3190.
[10]
Duarte C, Bastidas F, de los Reyes A, et al. Randomized controlled clinical trial comparing radioguided occult lesion localization with wire-guided lesion localization to evaluate their efficacy and accuracy in the localization of nonpalpable breast lesions[J]. Surgery, 2016, 159(4):1140-1145.
[11]
Kanat NB, Tuncel M, Aksoy T, et al. Comparison of wire-guided localization and radio-guided occult lesion localization in preoperative localization of nonpalpable breast lesions[J]. Turk J Med Sci, 2016, 46(6):1829-1837.
[12]
Mariscal Martinez A, Solà M, de Tudela AP, et al. Radioguided localization of nonpalpable breast cancer lesions: randomized comparison with wire localization in patients undergoing conservative surgery and sentinel node biopsy[J]. AJR Am J Roentgenol, 2009, 193(4):1001-1009.
[13]
Moreno M, Wiltgen JE, Bodanese B, et al. Radioguided breast surgery for occult lesion localization- correlation between two methods[J]. J Exp Clin Cancer Res, 2008, 27:29.
[14]
Postma EL, Verkooijen HM, Van Esser S, et al. Efficacy of 'radioguided occult lesion localisation’ (ROLL) versus 'wire-guided localisation’ (WGL) in breast conserving surgery for non-palpable breast cancer: a randomised controlled multicentre trial[J]. Breast Cancer Res Treat, 2012, 136(2):469-478.
[15]
Rampaul RS, Bagnall M, Burrell H, et al. Randomized clinical trial comparing radioisotope occult lesion localization and wire-guided excision for biopsy of occult breast lesions[J]. Br J Surg, 2004, 91(12):1575-1577.
[16]
Bloomquist EV, Ajkay N, Patil S, et al. A randomized prospective comparison of patient-assessed satisfaction and clinical outcomes with radioactive seed localization versus wire localization [J]. Breast J, 2016, 22(2):151-157.
[17]
Fung F, Cornacchi SD, Reedijk M, et al. Breast cancer recurrence following radioguided seed localization and standard wire localization of nonpalpable invasive and in situ breast cancers: 5-year follow-up from a randomized controlled trial[J]. Am J Surg, 2017, 213(4):798-804.
[18]
Gray RJ, Salud C, Nguyen K, et al. Randomized prospective evaluation of a novel technique for biopsy or lumpectomy of nonpalpable breast lesions: radioactive seed versus wire localization[J]. Ann Surg Oncol, 2001, 8(9):711-715.
[19]
Langhans L, Tvedskov TF, Klausen TL, et al. Radioactive seed localization or wire-guided localization of nonpalpable invasive and in situ breast cancer: A randomized, multicenter, open-label trial[J]. Ann Surg, 2017, 266(1):29-35.
[20]
Lovrics PJ, Goldsmith CH, Hodgson N, et al. A multicentered, randomized, controlled trial comparing radioguided seed localization to standard wire localization for nonpalpable, invasive and in situ breast carcinomas[J]. Ann Surg Oncol, 2011, 18(12):3407-3414.
[21]
彭庆蓥，胡大章. 全数字化乳腺X线引导下钙化灶导丝定位活组织检查对早期乳腺癌诊断的意义[J]. 肿瘤基础与临床，2012, 25(1):63-64.
[22]
吉华明，张继，夏建国. 全数字化X线乳腺钼靶、MRI对乳腺癌的诊断价值探讨[J/CD]. 中华普通外科学文献(电子版), 2013(4):295-297.
[23]
Thind CR, Desmond S, Harris O, et al. Radio-guided localization of clinically occult breast lesions (ROLL): a DGH experience[J]. Clin Radiol, 2005, 60(6):681-686.
[24]
Audisio RA, Nadeem R, Harris O, et al. Radioguided occult lesion localisation (ROLL) is available in the UK for impalpable breast lesions[J]. Ann R Coll Surg Engl, 2005, 87(2):92-95.
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