Separate cavity margin sampling at the time of initial breast lumpectomy significantly reduces the need for reexcisions
Separate cavity margin sampling at the time of initial breast lumpectomy significantly reduces the need for reexcisions
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DOI：
10.1097/01.pas.0000180448.08203.70
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发表时间：
2005-12-01
影响因子：
5.6
通讯作者：
Argani, P
中科院分区：
文献类型：
--
作者：
Cao, DF;Lin, C;Argani, P
在保乳治疗中，标本的边缘状态预测局部复发并决定是否需要再次切除。现在，许多外科医生在肿瘤切除术时采用多个单独的“腔边缘”（CM）（残留腔的整个壁）作为最终边缘，取代定向肿瘤切除术边缘（LM）。我们在126例患者中研究了这种方法的有效性（23例仅为导管原位癌[DCIS]，103例为浸润性癌伴或不伴DCIS），这些患者接受了定向乳房肿瘤切除术标本，并有4至6个额外的CM。对肿瘤进行以下评估：大小、分级、LM状态（肿瘤与边缘的距离，以及如果累及，累及程度）、血管侵犯、淋巴结状态以及是否存在广泛的导管内成分。对额外的CM标本进行残留癌（如有）及其与油墨真实边缘的距离的评估，并将结果与相应的LM相关联。只有大约50%的患者（103例中的52例）的组织学阳性LM（定义为2圈以内的油墨表面的癌）在其CM中有残留癌。额外的CM采样使得103例组织学阳性LM中的61例（59%）的总体最终切缘状态组织学阴性，因此显著减少了再次切除的需要。年轻患者的年龄，阳性LM的数量较多，高肿瘤分级，以及存在广泛的导管内成分的CM标本中残留癌的预测，而距离癌的油墨表面和肿瘤的程度参与的组织学阳性的LM没有。因为从组织学阳性LM患者中采集的CM标本通常没有肿瘤，我们怀疑许多阳性LM可能是假阳性。导致假阳性LM的可能因素包括墨水渗入到由过量墨水促进的样本缝隙中、肿瘤脆性促进肿瘤移位到墨水中、X线照片的样本操作和回缩伪影。
In breast conservation therapy, the margin status of the specimen predicts local recurrence and determines the need for reexcision. Many surgeons now take, at the time of lumpectomy, multiple separate "cavity margins" (CM) (the entire wall of the residual cavity) as final margins that supersede the oriented lumpectomy margins (LMs). We studied the efficacy of this method in 126 patients (23 with ductal carcinoma in situ [DCIS] only and 103 with invasive carcinoma with or without DCIS) who had an oriented lumpectomy specimen and also had four to six additional CMs. The tumors were evaluated for the following: size, grade, LM status (distance of tumor from margin and, if involved, extent of involvement), vascular invasion, lymph node status, and presence or absence of extensive intraductal component. The additional CM specimens were evaluated for residual carcinoma (if any) and its distance from the inked true margins, and the results were correlated with the corresponding LMs. Only approximately 50% of patients (52 of 103) with histologically positive LMs (defined as carcinoma within 2 turn of the inked surface) had residual carcinoma in their CMs. Additional CM sampling rendered the overall final margin status histologically negative in 61 of 103 (59%) cases with histologically positive LMs, therefore significantly reducing the need for reexcision. Younger patient age, higher number of positive LMs, high tumor grade, and the presence of extensive intraductal component were predictive of residual carcinoma in CM specimens, whereas the distance of carcinoma from the inked surface and the extent of tumor involvement of histologically positive LMs were not. Because CM specimens taken from patients with histologically positive LMs usually lack tumor, we suspect that many positive LMs are likely false positives. Possible factors accounting for false-positive LMs include seepage of ink into crevices of the specimen promoted by excessive inking, tumor friability promoting displacement of tumor into ink, manipulation of specimens for radiographs, and retraction artifact.