Cytologic evaluation of lumpectomy margins in patients with ductal carcinoma in situ: Clinical outcome
Cytologic evaluation of lumpectomy margins in patients with ductal carcinoma in situ: Clinical outcome
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DOI：
10.1007/bf02303749
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发表时间：
1997-12-01
影响因子：
3.7
通讯作者：
Nicosia, SV
中科院分区：
文献类型：
--
作者：
Cox, CE;Hyacinthe, M;Nicosia, SV
背景：由于最近报道的高复发率，乳腺原位癌(DCIS)的保乳治疗是有争议的。我们相信，肿块切除切缘的细胞学评估可以提高效率，降低DCI切除后的复发率。方法：在H.Lee Moffitt癌症中心和研究所前瞻性地积累了1255名乳腺癌患者的数据库，发现218名DCIS患者(17.4%)。在这218例中，114例接受了肿块切除、腋窝清扫和放射治疗；其余104例接受了乳房切除术加或不加重建术。印片细胞学用于评估所有肿块切除术切缘。结果：所有的肿块切除标本(114例116个肿瘤)都得到了评价。中位随访期为57.5个月(2~110个月)。103例患者104个肿瘤按单纯DCI(有或无微侵袭)进行治疗，其中7例(6.6%)行乳房切除、腋窝清扫和放射治疗。复发6例(6.1%)，中位复发时间47.5个月(27~85个月)，其中4例初诊时复发，2例未复发。结论：采用印片细胞学方法确定DCIS肿瘤切缘，可缩短手术时间，减少再切除率，总复发率为6.1%。5年后，显著的复发率与微侵袭和多灶性肿瘤(28%)和单纯性DCIS相关。DCIS的保乳治疗和印片细胞学确定手术切缘是治疗单纯性DCIS的一种经济有效和可靠的方法。
Backround: Breast conservation therapy is controversial for ductal carcinoma in situ (DCIS) due to recently reported high recurrence rates. We believe that cytologic evaluation of lumpectomy margins improves efficiency and leads to a lower recurrence rate following lumpectomy for DCIS.Methods: A prospectively accrued database of 1255 breast cancer patients at the H. Lee Moffitt Cancer Center and Research Institute was found to have 218 patients with DCIS (17.4%). Of those 218 cases, 114 were treated with lumpectomy, axillary dissection, and radiation therapy; the remaining 104 patients were treated with mastectomy with or without reconstruction. Imprint cytology was used to evaluate all lumpectomy margins. Permanent sections and imprint cytology were reviewed by the same pathologist.Results: All lumpectomy specimens (116 tumors in 114 patients) were evaluated. The median follow up was 57.5 months (range 2-110 months). One hundred and three patients with 104 tumors were selected on the basis of pure DCIS (with or without microinvasion), and treated with lumpectomy, axillary dissection and radiation therapy, Of the 104 tumors utilizing attempted breast conservation therapy, 7 (6.6%) required mastectomy. There were 6 recurrences (6.1%) with a median time for recurrence of 47.5 months (range 27-85 months): four recurrences were comedo and two were noncomedo at original diagnosis.Conclusions: The determination of lumpectomy margins in DCIS patients using imprint cytology leads to an overall recurrence rate of 6.1% with reduction in operative time, and re-excision rate. Significant recurrence rates were associated with microinvasion and multifocal tumors (28%) versus simple DCIS at 5 years. Breast conservation therapy and surgical margin determination with imprint cytology for DCIS is a cost-effective and reliable method of treatment for simple DCIS.