Role for intraoperative margin assessment in patients undergoing breast-conserving surgery
Role for intraoperative margin assessment in patients undergoing breast-conserving surgery
复制标题
DOI：
10.1245/s10434-006-9236-0
复制
发表时间：
2007-04-01
影响因子：
3.7
通讯作者：
Meric-Bernstam, Funda
中科院分区：
文献类型：
--
作者：
Cabioglu, Neslihan;Hunt, Kelly K.;Meric-Bernstam, Funda
背景：保乳手术（BCS）后，阳性/闭合切缘与较高的乳房内失败率相关。我们调查是否术中边缘评估艾滋病获得阴性利润率，并评估当地的控制，从而achieved.Methods：在1994年和1996年之间，264例患者进行BCS 0-III期乳腺癌[浸润性，n = 200;导管原位癌（DCIS），n = 64]。术中边缘评估包括大体组织检查，标本X线片，有或没有冷冻section.Results：92例（46%）与浸润性癌和24例（38%）与DCIS有积极的/关闭边缘上的永久部分分析其初始手术标本。58例浸润性癌患者（29%）和6例DCIS患者（9%）的初始切缘阳性/闭合，通过术中分析和立即再次切除，结果为切缘阴性。52例患者（20%）的永久病理学最终切缘为阳性/闭合：34例患者（17%）为浸润性癌，18例患者（28%）为DCIS。通过多变量分析，切除活检诊断，较大的肿瘤大小，多灶性与最终阳性/密切的边缘。在这52名患者中，23名接受了第二次手术以获得广泛的阴性切缘（13名完成乳房切除术，10名再次切除术）。BCS和放疗后同侧乳腺5年无复发生存率分别为99%浸润性癌（n = 167）和100% DCIS（n = 27）。结论：术中评估的利润率有助于确定积极/密切的利润率，并允许超过四分之一的患者在其原来的操作与术中再次切除边缘呈阴性。这种方法在接受BCS和放射治疗的患者中获得了极好的局部控制。
Background: Positive/close margins are associated with higher in-breast failure rates after breast-conserving surgery (BCS). We investigated whether intraoperative margin assessment aids in obtaining negative margins, and to evaluate the local control thus achieved.Methods: Between 1994 and 1996, 264 patients underwent BCS for stages 0-III breast cancer [invasive, n = 200; ductal carcinoma in situ (DCIS), n = 64]. Intraoperative margin assessment included gross tissue inspection, specimen radiography, with or without frozen section.Results: Ninety-two patients (46%) with invasive cancer and 24 (38%) with DCIS had positive/close margins on the permanent section analysis of their initial surgical specimens. Fifty-eight patients (29%) with invasive cancer and six (9%) with DCIS had initial positive/close margins, and were rendered margin-negative by intraoperative analysis and immediate re-excision. Final margins on permanent pathology were positive/close in 52 patients (20%): 34 patients (17%) with invasive cancer and 18 patients (28%) with DCIS. By multivariate analysis, excisional biopsy for diagnosis, larger tumor size, and multifocality were associated with final positive/close margins. Of these 52 patients, 23 underwent a second operation to achieve widely negative margins (13 completion mastectomies, 10 re-excisions). The 5-year ipsilateral breast recurrence-free survival rates after BCS and radiation were 99% for invasive cancer (n = 167) and 100% for DCIS (n = 27).Conclusions: Intraoperative assessment of margins assisted in identifying positive/close margins and allowed over a quarter of the patients to be rendered margin-negative with intraoperative re-excision at their original operation. This approach resulted in excellent local control in patients treated with BCS and radiation.