Intraoperative margin assessment reduces reexcision rates in patients with ductal carcinoma in situ treated with breast-conserving surgery
Intraoperative margin assessment reduces reexcision rates in patients with ductal carcinoma in situ treated with breast-conserving surgery
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DOI：
10.1016/s0002-9610(03)00264-2
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发表时间：
2003-10-01
影响因子：
3
通讯作者：
Kuerer, HM
中科院分区：
文献类型：
--
作者：
Chagpar, A;Yen, T;Kuerer, HM
背景：据报道，导管原位癌（DCIS）保乳手术后再切除以控制切缘的比率为48%至59%。DCIS患者术中边缘评估的最佳技术尚未确定。我们试图确定术中使用大体组织评估和切片标本放射摄影进行多学科评估是否减少了DCIS再次手术控制边缘的需要。方法：对1999年7月至2002年7月在我院行保乳手术的经芯针活检诊断为DCIS的患者进行前瞻性数据库整理。所有患者术中均进行了毛缘评估，并对整个和切片标本进行了钙化检查。结果：在研究期间，我们对4200例DCIS患者进行了评估。其中，160例患者在转诊前进行了切除活检诊断，92例患者的初始手术是乳房切除术，40例患者仅为第二意见而就诊，1例患者拒绝手术。剩下的109名患者构成了研究人群。中位年龄为55岁（34 - 81岁）。DCIS的中位病理大小为1.2 cm （0.2 ~ 8.0 cm）。59例患者术中评估切缘阳性（小于1 mm）或相近（小于5 mm）。59例患者中43例的最终病理结果与术中诊断的切缘阳性或近切缘一致（P = 0.00005）。75%在手术时被认为有阳性或接近切缘的患者（n = 44）进行了术中再切除。在109例患者中，31例（34%）患者术中再切除，导致切缘状态由术中评估阳性变为最终病理评估阴性（P < 0.00001）。只有24例（22%）患者需要第二次手术控制切缘。根据术中评估，在第一次手术中切除额外组织的决定导致控制切缘的第二次手术明显减少（P = 0.029）。结论：在DCIS患者中，术中通过大体病理检查和片样x线片评估切缘对术中决策有显著影响，术中根据评估进一步切除组织可显著减少二次手术切缘控制。(C) 2003年摘录医药股份有限公司版权所有。
Background: Reported rates of reexcision for margin control after breast-conserving surgery for ductal carcinoma in situ (DCIS) range from 48% to 59%. The optimal technique for intraoperative margin assessment in patients with DCIS has yet to be defined. We sought to determine whether intraoperative multidisciplinary evaluation using gross tissue assessment and sectioned-specimen radiography reduces the need for reoperation for margin control in DCIS.Methods: A prospectively compiled database was used to identify patients who had DCIS diagnosed by core needle biopsy and were treated with breast-conserving surgery at our institution between July 1999 and July 2002. All patients had intraoperative gross margin assessment and specimen radiography of both the whole and sliced specimen for calcifications.Results: Four hundred two patients with DCIS were evaluated at our institution during the study period. Of these, 160 had excisional biopsy for diagnosis prior to referral, 92 had mastectomy as their initial procedure, 40 were seen for a second opinion only, and 1 patient refused surgery. The remaining 109 patients formed the study population. The median age was 55 years (range 34 to 81). The median pathologic size of DCIS was 1.2 cm (range 0.2 to 8.0 cm). Fifty-nine patients had positive (less than I mm) or close (less than 5 mm) margins on intraoperative assessment. Final pathology agreed with intraoperative assessment of a positive or close margin in 43 of the 59 patients (P = 0.00005). Seventy-five percent of those thought to have a positive or close margin at the time of surgery (n = 44) underwent intraoperative reexcision. Of the total 109 patients, 31 (34%) had an intraoperative reexcision that resulted in a change in margin status from positive on intraoperative evaluation to negative on final pathologic evaluation (P < 0.00001). A second procedure for margin control was necessary in only 24 patients (22%). The decision to excise additional tissue at the first surgery on the basis of intraoperative assessment resulted in significantly fewer second procedures for margin control (P = 0.029).Conclusions: In patients with DCIS, intraoperative margin assessment by gross pathological examination and sliced specimen radiography significantly affects intraoperative decision making, and excision of further tissue on the basis of intraoperative assessment results in a substantial decrease in second procedures for margin control. (C) 2003 Excerpta Medica, Inc. All rights reserved.