国际肿瘤学杂志

国际肿瘤学杂志 ›› 2018, Vol. 45 ›› Issue (4): 197-201.doi: 10.3760/cma.j.issn.1673-422X.2018.04.002

• 论著 • 上一篇    下一篇

病理三维重建在乳腺癌保乳手术切缘评估及放疗调整中的应用

 邱恒,张爱苹,张朝蓬,刘雁冰,王春建,毕钊,徐乘骏,王永胜   

  1. 250117济南大学 山东省医学科学院医学与生命科学学院（邱恒、毕钊、徐乘骏）；山东大学附属山东省
    肿瘤医院乳腺病中心（邱恒、张朝蓬、刘雁冰、王春建、毕钊、徐乘骏、王永胜）；济南市第三人民医院肿瘤放疗科（张爱苹）
  • 出版日期:2018-04-08 发布日期:2018-05-16
  • 通讯作者: 王永胜，Email： wangysh2008@aliyun.com E-mail:wangysh2008@aliyun.com
  • 基金资助:

    国家自然科学基金（81672638）

Application of pathological three-dimensional reconstruction in margins assessment and radiotherapy adjustment of breast-conserving surgery

Qiu Heng, Zhang Aiping, Zhang Zhaopeng, Liu Yanbing, Wang Chunjian, Bi Zhao, Xu Chengjun, Wang Yongsheng.   

  1. School of Medicine and Life Sciences, University of Ji′nanShandong Academy of Medical Sciences; Breast Cancer Center, Shandong Cancer Hospital Affiliated to Shandong University, Ji′nan 250117, China
  • Online:2018-04-08 Published:2018-05-16
  • Contact: Wang Yongsheng, Email: wangysh2008@aliyun.com E-mail:wangysh2008@aliyun.com
  • Supported by:

    National Natural Science Foundation of China (81672638)

PDF

935

摘要： 目的 通过保乳手术切除标本的病理三维重建，重现肿瘤切除组织的原始三维构象，建立一种新的切缘评估模式，个体化指导保乳患者瘤床靶区的勾画。方法 选取山东省肿瘤医院乳腺病中心2016年2月至2017年2月行保乳手术的33例符合条件的乳腺癌患者，保乳手术切除标本制作成次连续病理大切片，并于显微镜下勾画出肿瘤的范围，利用Photoshop软件配准后于3D-DOCTOR软件进行病理三维重建，评估切缘状况，统计病理类型、肿瘤长径、三维阴性切缘距离。基于术腔边界金属夹勾画的大体肿瘤靶体积（GTV）分别均匀外扩1.00 cm、1.50 cm形成临床靶区(CTV)1、CTV2；基于三维重建后肿瘤三维边界分别均匀外扩1.00 cm、1.50 cm形成CTV3、CTV4。比较CTV1与CTV3、CTV2与CTV4的体积差异。结果基于病理三维重建的切缘评估结果，术中快速病理、术后常规病理切缘评估假阴性率分别为6.7%(2/30)、3.4%(1/29)。次连续病理大切片检查的病理类型与术后常规病理一致率为93.9%（31/33）。术后常规病理与病理三维重建测得肿瘤长径M(QR)分别为1.90(1.50～2.40)cm、2.00(1.60～2.70)cm，两组之间比较差异有统计学意义（Z=-2.438,P=0.015）。 CTV1、CTV2、CTV3和CTV4的体积M(QR)分别为70.76 (49.84～78.07）cm3、110.11 (83.38～126.17）cm3、 23.85 (16.46～31.49）cm3、38.74 (30.47～50.58）cm3，CTV1与CTV3、CTV2与CTV4之间的体积差异均有统计学意义（Z=-4.372，P<0.001；Z=-4.372，P<0.001）。结论 病理三维重建技术的应用可以在很大程度上弥补传统切缘评估模式的不足，使保乳术后的辅助治疗决策更为精确，同时可以个体化指导放疗靶区的勾画。

关键词: 乳腺肿瘤, 放射疗法, 成像, 三维, 靶区勾画

Abstract: Objective To reconstruct the original three-dimensional conformation of tumor resection tissue through the study of breast-conserving surgery  excision specimens for part-mount sub-serial section  and pathological three-dimensional (3D) reconstruction, to establish a new margin assessment model, and to guide tumor bed delineation individually for radiotherapy. Methods From February 2016 to February 2017， thirty-three eligible breast cancer patients underwent breast-conserving surgery in Breast Cancer Center of Shandong Cancer Hospital were recruited. The excision specimens were prepared with part-mount sub-serial section, and residual tumors were microscopically outlined, scanned and registered by Photoshop software. The 3D model of residual tumors was reconstructed with 3DDOCTOR software to evaluate margin status and record pathological type, tumor length and 3D negative margin distance. The gross tumor volume (GTV) was delineated based on clips placed in the lumpectomy cavity. CTV1 and CTV2 were defined by adding uniform 1.00 cm and 1.50 cm margin based on GTV respectively. CTV3 and CTV4 were defined by adding 1.00 cm and 1.50 cm margin based on 3D boundary of excision tumor respectively, and compared the volume differences of CTV1 and CTV3, CTV2 and CTV4. Results Based on the marginal assessment results of 3D pathological reconstruction, the rates of false negatives during the intraoperative rapid pathological examination and postoperative routine pathological margin evaluation were 6.7% (2/30) and 3.4% (1/29) respectively. The pathological type of pathological large slice and routine pathological examination was consistent with rate of 93.9%（31/33). The M(QR) tumor lengths of routine pathological and pathological 3D reconstruction were 1.90 (1.502.40)cm and 2.00 (1.602.70)cm respectively, with statistical difference between the two groups (Z=-2.438,P=0.015). The M(QR) volumes for CTV1, CTV2, CTV3, CTV4 were 70.76 (49.8478.07)cm3, 110.11 (83.38126.17）cm3, 23.85 (16.4631.49）cm3 and 38.74 (30.4750.58）cm3 respectively. There were statistical differences between CTV1 and CTV3, CTV2 and CTV4 （Z=-4.372, P<0.001; Z=-4.372, P<0.001）. Conclusion The application of pathological 3D reconstruction technology can largely compensate for the shortcomings of the traditional margin assessment model, make the decisions of adjuvant treatment after breastconserving surgery  more accurate, and guide the tumor bed delineation individually for radiotherapy.

Key words: Breast neoplasms, Radiotherapy, Imaging, three-dimensional, Target delineation