Impact of Routine Pathology Review on Treatment for Node-Negative Breast Cancer
Impact of Routine Pathology Review on Treatment for Node-Negative Breast Cancer
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DOI：
10.1200/jco.2011.38.9247
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发表时间：
2012-06-20
影响因子：
45.3
通讯作者：
Hayes, Malcolm
中科院分区：
文献类型：
--
作者：
Kennecke, Hagen F.;Speers, Caroline H.;Hayes, Malcolm
目的常规二次病理检查影响乳腺癌患者的诊断和治疗。淋巴结阴性乳腺癌患者的审查和导致管理变化的病理元素的性质的影响没有很好的描述。MethodsPatients与淋巴结阴性，浸润性，或原位乳腺癌和可评估的节点提到的不列颠哥伦比亚省癌症机构在2004年和2007年之间的两个时间段。具有乳腺癌专业知识的病理学家审查了原始报告和切片。未常规重复生物标志物检测。进行病历审查，以确定是否原始病理改变，是否推荐的治疗affected.ResultsAmong 906符合条件的患者，405（45%）收到了病理审查。单变量比较显示，接受审查的患者更年轻（P <0.001），更可能有接近的边缘（P <0.001），而其他特征相似。81例患者（20%）共记录了102处病理变化。最常改变的因素是分级（40%）和淋巴管（26%），淋巴结（15%）和边缘（12%）状态。这些变化导致25例患者（6%）进行了27次治疗调整。治疗的变化主要与淋巴结和边缘状态，只有两个27有关的测量雌激素受体阳性，淋巴结阴性乳腺癌的妇女的肿瘤生物学。ConclusionReported率的变化是显着的，并保证常规的二次病理检查淋巴结阴性乳腺癌或导管原位癌患者之间的最终治疗建议。在基因表达特征的时代，审查仍然是相关的，以确定边缘和淋巴结的状态。J Clin Oncol 30：2227-2231. (c)2012年美国临床肿瘤学会
PurposeRoutine secondary pathology review influences diagnosis and treatment among patients diagnosed with breast cancer. The impact of review on patients with node-negative breast cancer and the nature of the pathology elements leading to management changes are not well described.MethodsPatients with node-negative, invasive, or in situ breast cancer and evaluable nodes referred to the British Columbia Cancer Agency during two time periods between 2004 and 2007 were included. Pathologists with expertise in breast cancer reviewed the original reports and slides. Biomarker testing was not routinely repeated. Medical record review was conducted to determine whether original pathology was changed and whether recommended therapy was affected.ResultsAmong 906 eligible patients, 405 (45%) received a pathology review. Univariate comparisons revealed that reviewed patients were younger (P < .001) and more likely to have close margins (P < .001), whereas other characteristics were similar. A total of 102 pathology changes were documented among 81 patients (20%). The most frequently changed elements were grade (40%) and lymphovascular (26%), nodal (15%), and margin (12%) status. These changes resulted in 27 treatment modifications among 25 patients (6%). Treatment changes were primarily related to nodal and margin status, and only two of 27 were related to measurement of tumor biology in women with estrogen receptor-positive, node-negative breast cancer.ConclusionReported rates of change are significant and warrant routine secondary pathology review among patients with node-negative breast cancer or ductal carcinoma in situ before final treatment is recommended. Review remains relevant in the era of gene expression signatures to determine margin and nodal status. J Clin Oncol 30:2227-2231. (c) 2012 by American Society of Clinical Oncology