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中华乳腺病杂志(电子版) ›› 2026, Vol. 20 ›› Issue (05) : 272 -278. doi: 10.3877/cma.j.issn.1674-0807.2026.05.002

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乳腺癌保留乳房手术中精准定位与切缘评估技术的研究进展
李珂, 张译尹, 杨后圃, 王殊†()   
  1. 100044 北京,北京大学人民医院乳腺中心
  • 收稿日期:2026-04-30 出版日期:2026-10-01
  • 通信作者: 王殊

Precise localization and margin assessment techniques in breast-conserving surgery for breast cancer

Ke Li, Yiyin Zhang, Houpu Yang, Shu Wang†()   

  1. Department of Breast Center, Peking University People's Hospital, Beijing 100044, China
  • Received:2026-04-30 Published:2026-10-01
  • Corresponding author: Shu Wang
引用本文:

李珂, 张译尹, 杨后圃, 王殊. 乳腺癌保留乳房手术中精准定位与切缘评估技术的研究进展[J/OL]. 中华乳腺病杂志(电子版), 2026, 20(05): 272-278.

Ke Li, Yiyin Zhang, Houpu Yang, Shu Wang. Precise localization and margin assessment techniques in breast-conserving surgery for breast cancer[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2026, 20(05): 272-278.

保留乳房手术是在保证肿瘤学安全的基础上兼顾乳房外形和生活质量的重要治疗方式,精准定位病灶并获得阴性切缘是影响局部控制和再次手术决策的关键环节。当前保留乳房手术中的定位与切缘评估正由传统经验判断向影像引导、由二维定位向三维空间评估、由形态学识别向功能及分子信息融合、由人工判读向人工智能辅助决策发展。导丝及标记夹定位、术中超声、标本X线摄影及术中快速病理等技术已在临床中广泛应用,但在不可触及病灶、微钙化病变、多灶病变及新辅助治疗后残留病灶的判断中仍存在一定局限。近年来,染色示踪、三维标本成像、射频波谱、光学成像、分子靶向荧光成像及人工智能辅助判读等技术逐渐用于保留乳房手术中,为提高病灶识别、切缘评估和术中决策的客观性提供了新的思路。对于浸润性小叶癌、多灶病变或新辅助治疗后残留范围不清等切缘风险较高的病例,可结合术中多模态影像再评估、标本影像学、快速病理及必要的新型成像技术进行综合判断。本文围绕乳腺癌保留乳房手术中常用及新兴的精准定位与切缘评估技术进行阐述,以期为相关技术的合理选择和临床转化提供参考。

Breast-conserving surgery is an important therapeutic approach that aims to preserve breast appearance and quality of life while ensuring oncological safety. Accurate lesion localization and achievement of negative margins are key factors affecting local control and decisions regarding reoperation. At present, localization and margin assessment in breast-conserving surgery are evolving from experience-based judgment to image-guided decision-making, from two-dimensional localization to three-dimensional spatial assessment, from purely morphological recognition to the integration of functional and molecular information, and from manual interpretation to artificial intelligence-assisted decision support. Techniques such as wire-guided and clip-based localization, intraoperative ultrasound, specimen radiography, and intraoperative frozen pathological assessment have been widely used in clinical practice. However, these techniques still have certain limitations in assessing non-palpable lesions, microcalcifications, multifocal disease, and residual lesions after neoadjuvant therapy. In recent years, dye tracing, three-dimensional specimen imaging, radiofrequency spectroscopy, optical imaging, molecularly targeted fluorescence imaging, and artificial intelligence-assisted interpretation have gradually been applied in breast-conserving surgery, providing new approaches to improving the objectivity of lesion identification, margin assessment, and intraoperative decision-making. In patients at increased risk of positive margins, including those with invasive lobular carcinoma, multifocal disease, or unclear residual disease extent after neoadjuvant therapy, comprehensive evaluation should integrate intraoperative multimodal imaging reassessment, specimen imaging, rapid pathological assessment, and, when necessary, emerging imaging techniques. This review summarized commonly used and emerging techniques for precise localization and margin assessment in breast-conserving surgery for breast cancer patients, with the aim of providing a reference for the rational selection and clinical translation of these technologies.

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