Two-view versus single-view mammography at subsequent screening in a region of the Dutch breast screening programme

We retrospectively determined the effect of analogue two-view mammography versus single-view mammography at subsequent screens on breast cancer detection and determined financial consequences for a current digital mammography setting. Two screening radiologists reviewed the mammograms of 536 screen detected cancers (SDCs) and 171 interval cancers (ICs) with single-view mammography (medio-lateral-oblique view) at the last but one screen (SDCs) or latest screen (ICs). They determined whether two-view mammography at the last (but one) screen could have increased the cancer detection rate at that screening round. For subsequent screens, the radiologists also assessed the percentage of SDCs and ICs that had been missed at previous two-view screening mammography (SDC) or latest two-view screening (IC), respectively. Additional personnel and digital storage costs for standard two-view mammography at subsequent screening were calculated for digital screening. Two-view mammography could have facilitated earlier cancer detection in 40.9% (219/536) of SDCs and 39.8% (68/171) of ICs. For two-view screens, 24.4% of SDCs (213/871) were missed at previous two-view screening and 29.3% of ICs (110/375) were missed at the latest screen. Overall costs increase € 1.03/screen after implementation of digital two-view mammography. Standard two-view mammography at subsequent screening may modestly increase cancer detection at an earlier stage, whereas additional screening costs are limited.     

A retrospective audit of the first screening round of the Maltese breast screening programme

PurposeTo analyse whether the screening performance parameters of the Maltese National Breast Screening Programme first screening round met requirements set by European standards. The association between screening age and results of screening performance parameters was also investigated.MethodQuantitative methodology was used to review examinations of women who were recalled for a technical recall or further assessment rates. All accessible members of the population recalled during the first round were retrospectively reviewed resulting in a sample of 2300 recalled examinations.ResultsMalta's first screening round met the European Guidelines recommendations for technical repeat rate (0.26%), early recall rate (0.45%), breast cancer detection rate (13.77 per 1000 women) and Positive Predictive Value of screening test (7.58%). However, local recall rate (18.53%) and further assessment rate (18.27%) were higher than recommended.The Chi square test showed a statistically significant difference (p ≤ 0.05) in recall rates between the compared age groups, as younger women (51–55 years) were more likely to have a negative diagnosis after the initial mammogram whereas older women (56–60 years) were more likely to be recalled. There was no age discrepancy (p ≥ 0.05) in local breast cancer detection rate and positive predictive value of screening test.ConclusionAlthough the Maltese first screening round performed well, this study found deficiencies in recall and further assessment rates, which according to literature may result in psychological morbidity and inefficient use of screening resources. This study also concluded that when a cohort is analysed, age is not as significant as the screening round itself (first/subsequent).     

Mammography screening for breast cancer: Four years of nationwide screening in Finland

Biennial breast cancer screening with two-view screen-film mammography started on a nationwide basis in Finland in January 1987. Women have been invited by birth year cohort to attend a free-of-charge examination. The program has progressively expanded to include two or three new birth year cohorts yearly of women between 50 and 59 years of age. Participation has averaged 89% and the breast cancer detection rate has ranged from 3.8 to 3.3 per thousand compared with an expected annual incidence of breast cancer in this age group of 1.6 per thousand. The positive predictive value has increased from 33% to 53%. Results to date, collected by the radiologists responsible for each screening centre, indicate an acceptable sensitivity and specificity for the program. Specificity is much better than that which had generally been considered possible or practical. Double reading of all films, intensive training in both mammography and mammography screening, and careful evaluation of ongoing results by the radiologists involved are all believed to be important factors leading to a high sensitivity and specificity of mammography screening. Correspondence to: M. Pamilo     

The role of self-evaluation and education of radiographers involved in a breast cancer screening program at Clinical Hospital Center Rijeka

IntroductionEarly breast cancer detection can be achieved by enforcing the quality of mammography screening program. Hence, proper breast positioning is necessary. Systematic education of radiographers on mammographic positioning is a prerequisite for obtaining high-quality mammograms. The aim of this study is to demonstrate the importance of self-evaluation and education of radiographers involved in a breast cancer screening program.MethodsThe First School of Mammographic Positioning was organized in 2018 at Clinical Hospital Center (CHC) Rijeka and 24 radiographers included in the screening program attended. Four months after the School, an analysis and comparison of randomly selected mammograms was performed. Retrospective analysis was performed, and two sets of collected data were gathered from the period before and after the education. The quality criteria for evaluation were set and the mammograms were independently analyzed by two radiographers with experience in mammography. The chi-square test was used to perform statistical analysis.ResultsResults showed a statistically significant difference in the quality of mammograms before and after training for all criteria (p < 0.05).ConclusionSelf-evaluation and education of radiographers at the CHC Rijeka have led to a significant progress in image quality.Implications for practiceResults of this work imply that there is a strong need to formalize breast imaging education and the need to implement systematic education at the national level in Croatia.     

Integrated screening concept in women with genetic predisposition for breast cancer

Summary Breast cancer is in 5 % of cases due to a genetic disposition. BRCA1 and BRCA2 are by far the most common breast cancer susceptibility genes. For a woman with a genetic predisposition, the individual risk of developing breast cancer sometime in her life is between 70 and 90 %. Compared to the spontaneous forms of breast cancer, woman with a genetic predisposition often develop breast cancer at a much younger age. This is why conventional screening programs on the basis of mammography alone cannot be applied without modification to this high-risk group. In this article, an integrated screening concept for women with genetic predisposition for breast cancer using breast self-examination, clinical examination, ultrasound, mammography and magnetic resonance imaging is introduced.      

A randomised trial of screening with digital breast tomosynthesis plus conventional digital 2D mammography versus 2D mammography alone in younger higher risk women

IntroductionDigital breast tomosynthesis (DBT) has been shown to increase invasive cancer detection rates at screening compared to full field digital (2D) mammography alone, and some studies have reported a reduction in the screening recall rate. No prospective randomised studies of DBT have previously been published. This study compares recall rates with 2D mammography with and without concurrent DBT in women in their forties with a family history of breast cancer undergoing incident screening.Materials and methodsAsymptomatic women aged 40–49 who had previously undergone mammography for an increased risk of breast cancer were recruited in two screening centres. Participants were randomised to screening with 2D mammography only at the first study screen followed a year later by screening with 2D plus DBT, or vice versa. Recall rates were compared using an intention to treat analysis. Reading performance was analysed for the larger centre.Results1227 women were recruited. 1221 first screens (604 2D, 617 2D + DBT) and 1124 second screens (558 2D + DBT, 566 2D) were analysed. Eleven women had screen-detected cancers: 5 after 2D, 6 after 2D + DBT. The false positive recall rates were 2.4% for 2D and 2.2% for 2D + DBT (p = 0.89). There was a significantly greater reduction between rounds in the number of women with abnormal reads who were not recalled after consensus/arbitration with 2D + DBT than 2D (p = 0.023).ConclusionThe addition of DBT to 2D mammography in incident screening did not lead to a significant reduction in recall rate. DBT may increase reader uncertainty until DBT screening experience is acquired.     

Environmental,structural and process barriers in breast cancer screening for women with physical disability: A qualitative study

Breast cancer is the most common cancer in women internationally and is responsible for the deaths of thousands of women annually. Early detection of breast cancer is integral to ensure early intervention which increases survival rates and health outcomes for women. Despite the availability of breast cancer screening (BCS), previous research has identified that women with physical disability are less likely to access BCS and when they do, they encounter substantial barriers to these services. This paper presents the environmental, systemic and process barriers that women with physical disability face in undertaking BCS in New South Wales, Australia. A qualitative design was used to collect data via in-depth interviews which were audio-recorded, transcribed verbatim and thematically analysed. Twelve women with physical disability participated in interviews to share their experiences of BCS. Findings revealed that participants had both negative and positive experiences during BCS and are presented in the following four themes: Needing better access, Feeling like the machines aren't made for people like me; Experiencing health workers as being clinical and detached and; Facilitating and improving the experience of breast screening. Participants encountered substantial difficulties with the inflexibility of the diagnostic equipment. Further some conveyed that negative experiences of the procedure and interactions with staff while accessing mammography would deter them from returning for BCS. Informed and individualised care is required to enhance the experience of women with physical disability and thus increase uptake rates of this service.     

DWI in breast MRI: Role of ADC value to determine diagnosis between recurrent tumor and surgical scar in operated patients

Introduction

Purpose of our study is to evaluate the role of the apparent diffusion coefficient (ADC) in the diagnosis of recurrent tumor on the scar in patients operated for breast cancer. Assess, therefore, the weight of diagnostic diffusion echo-planar sequence, in association with the morphological and dynamic sequences in the diagnosis of tumor recurrence versus surgical scar.

Materials and methods

From September 2007 to March 2009, 72 patients operated for breast cancer with suspected recurrence on the scar were consecutively subjected to magnetic resonance imaging (MRI), including use of a diffusion sequence. All patients with pathological enhancement in the scar were then subjected to histological typing. MRI was considered negative in the absence of areas of suspicious enhancement. In all cases it was measured the ADC value in the scar area or in the area with pathological enhancement. The ADC values were compared with MRI findings and histological results obtained.

Results

26 cases were positive/doubtful at MRI and then subjected to histological typing: of these recurrences were 20 and benign were 6. 46 cases were judged negative at MRI and therefore not sent to cyto-histology. The average ADC value of recurrences was statistically lower of scarring (p < 0.001).

Conclusions

ADC value can be a specific parameter in differential diagnosis between recurrence and scar. The diffusion sequence, in association with the morphological and dynamic sequences, can be considered a promising tool for the surgical indication in suspected recurrence of breast cancer.     

Full-field digital mammography compared to screen film mammography in the prevalent round of a population-based screening programme: the Vestfold County Study

The purpose of the study was to compare the performance of full-field digital mammography (FFDM) with soft-copy reading to screen film mammography (SFM) used during the first prevalent 2-year round of population-based screening. A total of 18,239 women aged 50–69 years were screened with FFDM as part of the Norwegian Breast Cancer Screening Programme (NBCSP). Process indicators were compared to data from 324,763 women screened with SFM using the common national database of the NBCSP. The cancer detection rates were 0.77% (140/18,239) for FFDM and 0.65% (2,105/324,763) for SFM (p = 0.058). For ductal carcinoma in situ (DCIS) alone, the results were: FFDM 0.21% (38/18,239) compared to SFM 0.11% (343/324,763) (p < 0.001). Recall rates due to positive mammography were for FFDM 4.09% (746/18,239), while for SFM 4.16% (13,520/324,764) (p = 0.645), due to technically insufficient imaging: FFDM 0.22% (40/18,239) versus SFM 0.61% (1,993/324,763) (p < 0.001). The positive predictive value (PPV) in the FFDM group was 16.6% (140/843), while 13.5% (2,105/15,537) for SFM (p = 0.014). No statistically significant differences were recorded concerning histological morphology, tumour size, or lymph node involvement. In conclusion FFDM had a significantly higher detection rate for DCIS than SFM. For invasive cancers no difference was seen. FFDM also had a significantly higher PPV and a significantly lower technical recall rate.     

Factors influencing the uptake of 18F-fluoroestradiol in patients with estrogen receptor positive breast cancer

Introduction

¹⁸F-Fluoroestradiol (FES) PET imaging provides a non-invasive method to measure estrogen receptor (ER) expression in tumors. Assessment of factors that could affect the quantitative level of FES uptake is important as part of the validation of FES PET for evaluating regional ER expression in breast cancer.

Methods

This study examines FES uptake in tumors from 312 FES PET scans (239 patients) with documented ER+ primary breast cancer. FES uptake was compared to clinical and laboratory data, treatment prior to or at time of scan, and properties of FES and its metabolism and transport. Linear mixed models were used to explore univariate, threshold-based and multivariate associations.

Results

Sex hormone-binding globulin (SHBG) was inversely associated with FES SUV. Average FES uptake did not differ by levels of plasma estradiol, age or rate of FES metabolism. FES tumor uptake was greater for patients with a higher body mass index (BMI), but this effect did not persist when SUV was corrected for lean body mass (LBM). In multivariate analysis, only plasma SHBG binding was an independent predictor of LBM-adjusted FES SUV.

Conclusions

Calculation of FES SUV, possibly adjusted for LBM, should be sufficient to assess FES uptake for the purpose of inferring ER expression. Pre-menopausal estradiol levels do not appear to interfere with FES uptake. The availability and binding properties of SHBG influence FES uptake and should be measured. Specific activity did not have a clear influence on FES uptake, except perhaps at higher injected mass per kilogram. These results suggest that FES imaging protocols may be simplified without sacrificing the validity of the results.     

The effect of changing from one to two views at incident (subsequent) screens in the NHS breast screening programme in England: impact on cancer detection and recall rates

AIM: To assess the effect on cancer detection and recall rates of changing from one to two views for incident (subsequent) screens. METHODS: Controlled, comparative, observational study of programmes in NHS breast screening programme in England. Subjects: women aged 50-64 years were screened by the NHSBSP between 1 April 2001 and 31 March 2003. RESULTS: The effect of changing to two-view mammography was a 20% increase in overall incident screen cancer detection rate, with the biggest effect seen for small (<15 mm) invasive cancers. This increased detection rate was achieved with an 11% drop-in recall rate. CONCLUSION: The introduction of two-view mammography for incident screens has resulted in considerable improvements in overall NHS breast screening performance.     

Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings

The main purpose was to compare breast cancer visibility in one-view breast tomosynthesis (BT) to cancer visibility in one- or two-view digital mammography (DM). Thirty-six patients were selected on the basis of subtle signs of breast cancer on DM. One-view BT was performed with the same compression angle as the DM image in which the finding was least/not visible. On BT, 25 projections images were acquired over an angular range of 50 degrees, with double the dose of one-view DM. Two expert breast imagers classified one- and two-view DM, and BT findings for cancer visibility and BIRADS cancer probability in a non-blinded consensus study. Forty breast cancers were found in 37 breasts. The cancers were rated more visible on BT compared to one-view and two-view DM in 22 and 11 cases, respectively, (p < 0.01 for both comparisons). Comparing one-view DM to one-view BT, 21 patients were upgraded on BIRADS classification (p < 0.01). Comparing two-view DM to one-view BT, 12 patients were upgraded on BIRADS classification (p < 0.01). The results indicate that the cancer visibility on BT is superior to DM, which suggests that BT may have a higher sensitivity for breast cancer detection.     

Diffuse optical tomography of the breast: preliminary findings of a new prototype and comparison with magnetic resonance imaging

This paper presents an evaluation of a prototype diffuse optical tomography (DOT) system. Seventeen women with 18 breast lesions (10 invasive carcinomas, 2 fibroadenomas, and 6 benign cysts; diameters 13–54 mm) were evaluated with DOT and magnetic resonance imaging (MRI). A substantial fraction of the original 36 recruited patients could not be examined using this prototype due to technical problems. A region of interest (ROI) was drawn at the lesion position as derived from MRI and at the mirror image site in the contralateral healthy breast. ROIs were assessed quantitatively and qualitatively by two observers independently in two separate readings. Intra- and interobserver agreements were calculated using kappa statistics (k) and intraclass correlation coefficients (ICCs). Discriminatory values for presence of malignancy were determined by receiver operating characteristic (ROC) analyses. Intraobserver agreements were excellent (k 0.88 and 0.88; ICC 0.978 and 0.987), interobserver agreements were good to excellent (k 0.77–0.95; ICC 0.96–0.98). Discriminatory values for presence of malignancy were 0.92–0.93 and 0.97–0.99 for quantitative and qualitative ROC analysis, respectively. This DOT system has the potential to discriminate malignant from benign breast tissue in a reproducible qualitative and quantitative manner. Important technical improvements are required before this technique is ready for clinical application.     

Tumour characteristics and survival in patients with invasive interval breast cancer classified according to mammographic findings at the latest screening: a comparison of true interval and missed interval cancers

The aim of this study was to investigate whether different mammographic categories of interval cancer classified according to findings at the latest screening are associated with different distributions of prognostic factors or with different survival rates. The series consisted of all patients with invasive interval cancer detected from May 1978 to August 1995 (n = 544). The tumours were evaluated with regard to age, radiological category, interval between the latest screen and diagnosis and tumour characteristics at the time of diagnosis. We investigated possible relationships between the survival rate of patients with interval cancer and the interval between the latest screen and diagnosis, tumour characteristics and radiological category of the interval tumours. The study focused on comparison of patients with true interval and missed interval cancer. Women with mammographically occult tumours were younger than those in the other radiological categories. Comparisons of true interval cancers with overlooked or misinterpreted tumours showed equal distributions of age, tumour size, TNM stage and lymph node status. The overlooked or misinterpreted tumours showed significantly higher proportions of grade-I tumours (22 vs 11 %), tumours with low S-phase fraction (SPF; 44 vs 24 %) and oestrogen receptor (ER) positive tumours (72 vs 57 %). However, analyses of survival rates disclosed no clear differences between the two radiological categories. Radiological category and interval between the latest screen and diagnosis were not genuine predictors of the prognosis in patients with invasive interval breast cancer. No certain prognostic difference existed between true interval cancers and overlooked or misinterpreted interval breast cancers, despite higher proportions of grade-I tumours, ER positive tumours and tumours with low SPF in the latter group. Received: 17 December 1997; Revision received: 6 May 1998; Accepted: 27 May 1998     

The positive predictive value of the breast imaging reporting and data system (BI-RADS) as a method of quality assessment in breast imaging in a hospital population

Evaluation of the diagnostic performance of mammography and US in our hospital, based upon the positive predictive value (PPV) for breast cancer of the breast imaging reporting and data system (BI-RADS) final assessment categories, has been performed. A follow-up study of 2,762 mammograms was performed, along with 955 diagnostic exams and 1,807 screening exams. Additional US was performed in 655 patients (23.7%). The combined reports were assigned a BI-RADS category. Follow-up was obtained by pathologic examination, mammography at 12 months or from PALGA, a nationwide network and registry of histo- and cytopathology. Overall sensitivity was 85% (specificity 98.7%); sensitivity of the diagnostic examinations was 92.9% (specificity 97.7%) and of the screening examinations 69.2% (specificity 99.2%). The PPV of BI-RADS 1 was 5 of 1,542 (0.3%), and of BI-RADS 2, it was 6 of 935 (0.6%). BI-RADS 3 was 6 of 154 (3.9%), BI-RADS 4 was 39 of 74 (52.7%) and BI-RADS 5 was 57 of 57 (100%). The difference between BI-RADS 1 and 2 vs. BI-RADS 3 was statistically significant (P<0.01). Analysis of BI-RADS 3 cases revealed inconsistencies in its assignment. Evaluation of the BI-RADS final assessment categories enables a valid analysis of the diagnostic performance of mammography and US and reveals tools to improve future outcomes.     

乳腺癌的钼靶X线诊断（216例报告及文献复习）

目的提高钼靶X线对乳腺癌的诊断水平。方法回顾性分析了经手术病理证实的216例乳腺癌的钼靶X线表现。结果本组216例患者中，钼靶X线正确诊断180例，诊断准确率为83．33％。病变位于外上象限116例（53．70％）；清晰显示肿块者150例（69．44％），有毛刺者48例（22．22％），钙化者128例（59．26％），腺体结构紊乱、扭曲伴非对称性致密影者24例（11．11％）。结论钼靶X线摄影能很好地反映乳腺癌的病理特征，因而对乳腺癌的早期诊断与鉴别诊断有重要意义。     

Lymphoscintigraphic sentinel node identification in patients with breast cancer: the role of SPECT-CT

Purpose Lymph node status is a major factor in determining the stage, appropriate therapy and outcome in patients with breast cancer. It is therefore of clinical importance to accurately identify all sentinel nodes (SNs) for each individual tumour before surgery. The purpose of this study was to assess the role of SPECT-CT lymphoscintigraphy in SN identification in patients with breast cancer.Methods Lymphoscintigraphy comprising planar and SPECT-CT acquisition was performed in 157 consecutive patients with breast cancer (mean age 54.7±10.6, range 27–81 years) with a palpable mass (n=100), with a non-palpable mass (n=52) or post lumpectomy (n=5). Planar and SPECT-CT images were interpreted separately and the two imaging techniques were compared with respect to their ability to identify hot nodes.Results Planar imaging alone was negative for identification of hot nodes in 15% of the patients. SPECT-CT alone was negative in 10% and both techniques were negative in 9% of the patients. Forty-six of the total of 361 (13%) hot nodes identified by lymphoscintigraphy were detected only on SPECT-CT, including 21 nodes obscured by the scattered radiation from the injection site, nine adjacent nodes misinterpreted on planar images as a single node and 16 nodes which were missed on planar images and detected on SPECT data. SPECT-CT detected additional sites of drainage unexpected on planar images, including axillary (n=23 patients), internal mammary (n=5 patients), interpectoral (n=3 patients) and intramammary (n=2 patients) lymph node sites. Fourteen of the 329 (4%) hot lesions seen on planar images were false positive non-nodal sites of uptake that were accurately assessed by SPECT-CT and further validated by surgery. In a single patient, SPECT-CT was negative while planar images identified the SN.Conclusion SPECT-CT may improve the preoperative localisation of draining nodes in patients with breast cancer. It may detect hot nodes missed by planar imaging, exclude non-nodal false positive sites of uptake and accurately localise axillary and extra-axillary nodes.     

Contrast-enhanced spectral mammography in recalls from the Dutch breast cancer screening program: validation of results in a large multireader,multicase study

Objectives

Contrast-enhanced spectral mammography (CESM) is a promising problem-solving tool in women referred from a breast cancer screening program. We aimed to study the validity of preliminary results of CESM using a larger panel of radiologists with different levels of CESM experience.

Methods

All women referred from the Dutch breast cancer screening program were eligible for CESM. 199 consecutive cases were viewed by ten radiologists. Four had extensive CESM experience, three had no CESM experience but were experienced breast radiologists, and three were residents. All readers provided a BI-RADS score for the low-energy CESM images first, after which the score could be adjusted when viewing the entire CESM exam. BI-RADS 1-3 were considered benign and BI-RADS 4-5 malignant. With this cutoff, we calculated sensitivity, specificity and area under the ROC curve.

Results

CESM increased diagnostic accuracy in all readers. The performance for all readers using CESM was: sensitivity 96.9 % (+3.9 %), specificity 69.7 % (+33.8 %) and area under the ROC curve 0.833 (+0.188).

Conclusion

CESM is superior to conventional mammography, with excellent problem-solving capabilities in women referred from the breast cancer screening program. Previous results were confirmed even in a larger panel of readers with varying CESM experience.

Key Points

? CESM is consistently superior to conventional mammography ? CESM increases diagnostic accuracy regardless of a reader’s experience ? CESM is an excellent problem-solving tool in recalls from screening programs

     

MR mammography in the pre-operative staging of breast cancer in patients with dense breast tissue: comparison with mammography and ultrasound

The aim of this study was to determine whether pre-operative MR mammography could predict the extent of breast cancer in patients with dense breasts or whether dense parenchyma will lead to false-positive or inconclusive examinations. Sixty-seven patients with dense breasts with a malignant breast tumor planned for conservative surgery were reviewed. Detection rates of mammography, ultrasound, and MR mammography were studied, and the diameters of the lesions were measured and compared with pathological examination. Pathology revealed breast cancer in 65 patients. Sensitivity for detection of index lesions was 83% for mammography, 70.8% for ultrasound, and 98% for MR mammography. Mammography underestimated tumor extent in 37%, ultrasound in 40%, and MR in 12.5%. Of the 20 patients (31%) with multifocal or multicentric carcinoma, mammography detected the lesions in 35%, ultrasound in 30%, and MR in 100%, with a false-positive rate of 12.5, 14, and 23%. The MR mammography is more accurate in assessing tumor extent and multifocality in patients with dense breasts, but benign changes may lead to false-positive examinations.     

达芬奇机器人手术系统胸外科手术切口选择:661例手术经验分析

目的总结达芬奇机器人手术系统(DVSS)在661例普胸外科手术中应用的临床经验。方法回顾性分析自2011年3月至2016年2月沈阳军区总医院胸外科应用DVSS对661例患者进行胸外科手术的临床资料。整个手术过程分为:(1)诱导麻醉;(2)摆体位,设计Trocar分布、安装机械臂(有些病变部位在摆体位前需要CT引导下定位);(3)寻找病变部位、进行手术治疗。根据患者病变部位所设计的手术部位及切口位置设计胸外科Trocar排布,总结我科不同病变部位的Trocar位置选择、手术入路选择、相关术中与术后情况及并发症治疗的经验体会。结果本组共661例患者,包括372例肺部手术,286例纵膈手术和3例食管手术。肺部手术设计了"8857"孔法手术入路,70/372例需要术前定位;60/372例胸腔内重度粘连,但顺利完成DVSS手术,未转成开胸手术。纵膈手术(包括心包囊肿或占位)设计4种手术入路,45/286例术中、术后未留置引流管。3例食管手术主要是食管壁内肿物。6/661例患者术后出现乳糜胸,1例为纵膈术后,5例为肺部术后。经保守治疗后,4/6例痊愈,1/6例再次行DVSS手术治疗(经左胸乳糜胸清除,胸导管结扎术),1/6例死亡。其中,1/655例患者术后因出现心梗死亡(术后1 h内);1/661例术中出现大出血,均并转为开胸手术治疗。78/655例患者(除外乳糜胸患者)术后引流管带管时间过长(带管超过5 d),无其他严重并发症。结论总体来说,DVSS在胸外科手术中的应用是安全、有效的,人工气胸的建立、患者自身的耐受性、第一个Trocar位置的选择及胸腔里粘连的情况,对手术成功与否起重要作用。