Aref A, Youssef E, Washington T, Segel M, Grigorian C, Bongers S, Bouwman D
Department of Radiation Oncology, Barbara Ann Karmanos Cancer Institute and Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
Cancer J Sci Am. 2000 Jan-Feb;6(1):25-7.
It is recommended that patients with breast cancer who present with mammographically detected microcalcification should undergo postlumpectomy mammogram with magnification views to ensure adequate removal of all clinically demonstrable disease. The value of postlumpectomy mammogram has not been adequately examined in the literature. This report aims to quantify the value of such a study.
Retrospective review identified 90 breast cancer patients referred to our department between 1992 and 1997 who met all of the following criteria: (1) patients were considered for breast conserving management; (2) patients had suspicious microcalcifications on diagnostic mammograms; (3) the mammographic lesions were thought to be removed entirely on postexcision specimen radiographs; (4) surgical excisions were thought to be adequate on the basis of a review of the histologic pathology reports; and (5) postlumpectomy mammograms with magnification views were obtained. Fifty patients had invasive adenocarcinoma and 40 patients had ductal carcinoma in situ. The margins of last resection were clear, close, or focally involved in 70, 13, and seven patients, respectively. Patient records were reviewed to determine whether postlumpectomy mammograms demonstrated residual microcalcifications.
Sixteen patients (17%) were found to have residual microcalcifications on postlumpectomy mammograms. Twelve patients underwent either local re-excision (seven patients) or simple mastectomy (five patients). Re-excision was not performed in four patients. Residual malignant cells were found in eight patients (67% of the re-excision group and 9% of the whole group). Six of these patients had their tumors initially resected with clear margins and the remaining two patients had their tumors initially resected with close margins.
Postlumpectomy mammograms with magnification views detected residual clinical disease in a significant proportion of patients. Our result supports the routine use of this test, even when satisfactory postexcision specimen radiographs and adequate lumpectomy resection margins are obtained. This finding is particularly true for patients with ductal carcinoma in situ.
建议对乳腺钼靶检查发现微钙化的乳腺癌患者进行保乳术后放大钼靶检查，以确保彻底切除所有临床可检测到的病灶。保乳术后钼靶检查的价值在文献中尚未得到充分研究。本报告旨在量化该项检查的价值。
回顾性研究纳入了1992年至1997年间转诊至我科的90例乳腺癌患者，这些患者均符合以下所有标准：（1）考虑进行保乳治疗；（2）诊断性钼靶检查发现可疑微钙化；（3）钼靶检查病变在切除标本X线片上被认为已完全切除；（4）根据组织病理学报告回顾，认为手术切除充分；（5）获得了保乳术后放大钼靶检查结果。50例患者为浸润性腺癌，40例患者为导管原位癌。最后一次切除的切缘分别在70例、13例和7例患者中为阴性、接近阳性或局部受累。查阅患者记录以确定保乳术后钼靶检查是否显示残留微钙化。
16例患者（17%）保乳术后钼靶检查发现残留微钙化。12例患者接受了局部再次切除（7例）或单纯乳房切除术（5例）。4例患者未进行再次切除。8例患者（再次切除组的67%，整个组的9%）发现残留恶性细胞。其中6例患者最初切除肿瘤时切缘阴性，其余2例患者最初切除肿瘤时切缘接近阳性。
保乳术后放大钼靶检查在相当比例的患者中检测到残留临床病灶。我们的结果支持常规使用该项检查，即使获得了满意的切除标本X线片和充分的保乳切除切缘。这一发现对于导管原位癌患者尤为适用。
