The value of breast lumpectomy margin assessment as a predictor of residual tumor burden in ductal carcinoma in situ of the breast
The value of breast lumpectomy margin assessment as a predictor of residual tumor burden in ductal carcinoma in situ of the breast
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DOI：
10.1002/cncr.10460
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发表时间：
2002-04-01
期刊：
影响因子：
6.2
通讯作者：
Wazer, DE
中科院分区：
文献类型：
--
作者：
Neuschatz, AC;DiPetrillo, T;Wazer, DE
背景切缘宽度被认为是乳腺导管原位癌（DCIS）局部复发的最重要危险因素。本报告的目的是评估肿瘤切除术标本边缘评估的预测效用的存在和残留DCIS的程度。本文对253例乳腺导管原位癌（DCIS）行肿瘤切除及再切除的标本进行了研究，以确定DCIS再切除后残留的可能性。根据肿瘤大小、边缘状态、细胞核分级、是否存在坏死、患者年龄和标本处理程度（切片数量/组织体积）评价残留肿瘤的概率。病变按大小分组：小于或等于2 mm，大于2-15 mm，边缘宽度记录为DCIS到最近的标本边缘的距离，或者对于阳性边缘，评分为：广泛（边缘累及：8个切片或>4个低倍视野[LPF]）、中等（5-7个切片或2-4个LPF）、最小（2-4个切片或1个LPF）或局灶性（1个切片，单个病灶）。残留肿瘤的数量根据最大尺寸进行半定量分级。结果。初次切除的切缘可显著预测再次切除时肿瘤残留的存在。广泛阳性者85%，中度阳性者68%，轻度阳性者46%，局灶性阳性者30%，大于0-1 mm者41%，大于1-2 mm者31%，大于2 mm者0%（P < 0.0001）。在单变量分析中，初次切除标本的边缘宽度和病变大小显著预测再次切除时残留DCIS的存在。年龄、分级、坏死和标本处理程度不是显著的预后因素。在多变量分析中，初始切缘宽度（P < 0.0001）和病变大小（P = 0.02）均能显著预测残留DCIS。至于残留肿瘤的数量，边缘宽度和初始病变的尺寸都显着预测中等至大残留，而年龄45岁或以下的单变量分析的边缘意义。在多变量分析中，切缘宽度和初次切除时的病灶大小仍然是较大体积残留肿瘤的重要预测因素。DCIS肿块切除标本的边缘状态是残留病变存在和数量的最重要预测因素。
BACKGROUND. Margin width is considered the most important risk factor for local recurrence in ductal carcinoma in situ (DCIS) of the breast. The purpose of this report is to assess the predictive utility of lumpectomy specimen margin assessment for the presence and extent of residual DCIS.METHODS. Specimens from 253 DCIS cases with lumpectomy and reexcision were studied to determine to the probability of residual DCIS on reexcision. The probability of residual tumor was evaluated with respect to tumor size, margin status, nuclear grade, presence of necrosis, patient age, and the extent of specimen processing (number of sections/volume tissue). Lesions were grouped by size: less than or equal to 2 mm, greater than 2-15 mm., greater than 15-40 mm, or greater than 40 mm. Margin width was recorded as the distance of DCIS to the closest specimen edge or, for positive margins, scored as: extensive (margin involvement in :8 sections or >4 low-power fields [LPFs]), moderate (5-7 sections or 2-4 LPFs), minimal (2-4 sections or 1 LPF), or focal (1 section, single focus). The amount of residual tumor was graded by maximum dimension on a semiquantitative basis.RESULTS. Initial excision margin significantly predicted for the presence of residual tumor on reexcision. Residual tumor was found on reexcision in 85% of extensively positive, 68% of moderately positive, 46% of minimally positive, 30% of focally positive, 41% of greater than 0-1 mm, 31% of greater than 1-2 mm, and 0% of greater than 2 mm margins (P < 0.0001). On univariate analysis, margin width and lesion size of initial excision specimens significantly predicted for the presence of residual DCIS on reexcision. Age, grade, necrosis, and extent of specimen processing were not significant prognostic factors. On multivariate analysis, both initial margin width (P < 0.0001) and lesion size (P = 0.02) significantly predicted for residual DCIS. As for amount of residual tumor, margin width and initial lesion dimension both significantly predicted for medium to large residuum, whereas age 45 years or younger was of borderline significance on univariate analysis. On multivariate analysis, margin width and lesion size on initial excision both remained significant predictors of larger volume residual tumor.CONCLUSIONS. The margin status of a DCIS lumpectomy specimen is the most important predictive factor for both the presence and amount of residual disease.