Mapping biopsy with punch biopsies to determine surgical margin in extramammary Paget's disease
Mapping biopsy with punch biopsies to determine surgical margin in extramammary Paget's disease
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DOI：
10.1111/1346-8138.12347
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发表时间：
2013-12-01
影响因子：
3.1
通讯作者：
Tanaka, Toshihiro
中科院分区：
文献类型：
--
作者：
Kato, Takeshi;Fujimoto, Noriki;Tanaka, Toshihiro
乳房外佩吉特病（EMPD）的手术切缘难以确定。据报道，尽管使用莫氏显微手术（MMS），这是常见的复发率高。术前标测活检比MMS更容易进行。在日本，建议采用以下方法代替MMS：边界清楚的和经标测活检组织学证实的边缘应切除1 cm边缘，边界不清的应切除3 cm边缘。本研究旨在评价日本指南的准确性，并评估我们的标测活检方法与MMS的比较。在每位患者的至少四个方向上获得超出临床边界的术前标测活检标本。为了证实术后残留佩吉特细胞的存在，沿手术切缘沿着获得狭窄的标本。对17例EMPD患者的佩吉特细胞的组织学扩散和复发率进行了回顾性评价。有86个方向显示边界清晰，9.3%（8/86）的佩吉特细胞仍在1 cm切除线处观察到。另一方面，有21个方向显示边界不清，90%（19/21）的方向进行了不必要的根治性切除，切除线为3cm。虽然术后组织学检查显示佩吉特细胞残留在47%（8/17）的患者中，并且没有进行额外的切除，但复发率仅为5.9%（1/17）。EMPD的切除线不应根据临床特征，而应根据标测活检。标测活检在复发率方面与MMS相当，尽管是常规方法，但仍是治疗EMPD的有效方法。
It is difficult to determine the appropriate resection margin of extramammary Paget's disease (EMPD). A high recurrence rate is reported in spite of using Mohs micrographic surgery (MMS), which is performed commonly. Preoperative mapping biopsy is easier to perform than MMS. In Japan, the following method is recommended instead of MMS: well-defined border and margins histologically confirmed by mapping biopsy should be resected with 1-cm margin and ill-defined border with 3-cm margin. This study aimed to evaluate the accuracy of the Japanese guideline and to assess our mapping biopsy method compared with MMS. Preoperative mapping biopsy specimens were obtained beyond the clinical border for at least four directions in each patient. To confirm the presence of residual Paget's cells postoperatively, narrow specimens were obtained along the surgical margin. Retrospective evaluation of 17 EMPD patients was conducted concerning histological spread of Paget's cells and recurrence ratio. There were 86 directions showing a well-defined border, and in 9.3% (8/86), Paget's cells were still observed at 1-cm resection line. On the other hand, there were 21 directions showing an ill-defined border, and unnecessary radical resection was performed in 90% (19/21) of directions with 3-cm resection line. Although postoperative histological examination showed residual Paget's cells in 47% (8/17) of patients and additional resections were not performed, recurrence rate was only 5.9% (1/17). The resection line of EMPD should be based not on clinical features, but on mapping biopsy. Mapping biopsy is equivalent to MMS concerning recurrence rate and, though conventional, is useful method to treat EMPD.