Mai K T, Chaudhuri M, Perkins D G, Mirsky D
Division of Anatomical Pathology, Department of Laboratory Medicine, The Ottawa Hospital, Civic Campus, University of Ottawa, Ottawa, Ontario, Canada.
J Surg Oncol. 2001 Nov;78(3):189-93. doi: 10.1002/jso.1147.
The strategy for surgical treatment of breast carcinoma proven by biopsy is mainly based on the physical and mammographic examinations. To investigate if the pathological findings in core biopsy are contributory to planning the surgical strategy, we correlated the status of ductal carcinoma in situ (DCIS) in the core needle biopsy of breast, the mammographic changes and the status of resection margins in the subsequent lumpectomy.
Consecutive 130 core needle biopsies with prior mammography and subsequent lumpectomy were reviewed. Biopsies were divided into: group I, DCIS; group II, DCIS and infiltrating carcinoma (IC); and group III, IC. Mammographic findings were categorized into four groups: (a) nonspecific findings; (b) calcification (Ca(++)); Ca(++) and mass, and mass only. The status of margins in correlating lumpectomy specimens was reviewed. Close margin was defined as a free margin at less than 0.1cm from the carcinoma.
The rates of positive or close margins in three groups I, II, and III were 13/18, 18/48, and 2/64 (P < 0.001); and in mammography groups of nonspecific finding, Ca(++), Ca(++) mass and mass only were 5/6, 7/15, 8/37, and 13/72 (P < 0.001), respectively. Of the total of 14 cases with positive margins of more than 0.5 cm in length, 8, 4, and 2 cases were from group I, II, and II, respectively. In addition, 13 of 21 cases with nonspecific changes or with only Ca(++) in mammograms belonged to the group I; 10 of these 13 cases were associated with positive margins. Forty-one of 72 cases presenting as a mass only in mammograms belonged to the group III; only 2 of these 41 cases were associated positive margins.
Correlation of the extent of carcinoma with pre-operative histopathological findings was better than with mammography. Core biopsies containing only DCIS, particularly in cases with nonspecific findings or with only Ca(++) in mammograms, represent a group of breast carcinoma that pose the high risk for incomplete resection in lumpectomy. Surgical management of patients having these cores includes wider resection margins than would otherwise be taken. Most core biopsies with only IC were associated with negative margins.
经活检证实的乳腺癌手术治疗策略主要基于体格检查和乳房X线检查。为了研究粗针活检的病理结果是否有助于制定手术策略，我们将乳腺粗针活检中的导管原位癌（DCIS）状态、乳房X线改变以及后续肿块切除术中的切缘状态进行了关联分析。
回顾性分析了130例先后接受乳房X线检查及后续肿块切除术的连续粗针活检病例。活检病例分为：I组，DCIS；II组，DCIS和浸润性癌（IC）；III组，IC。乳房X线检查结果分为四类：（a）非特异性表现；（b）钙化（Ca(++)）；Ca(++)和肿块，以及仅表现为肿块。对相关肿块切除标本的切缘状态进行了评估。切缘接近定义为癌灶边缘小于0.1cm的切缘。
I、II、III三组的阳性或切缘接近率分别为13/18、18/48和2/64（P<0.001）；乳房X线检查非特异性表现、Ca(++)、Ca(++)合并肿块以及仅表现为肿块组的切缘接近率分别为5/6、7/15、8/37和13/72（P<0.001）。在切缘阳性长度超过0.5cm的14例病例中，分别有8例、4例和2例来自I组、II组和III组。此外，乳房X线检查表现为非特异性改变或仅Ca(++)的21例病例中有13例属于I组；这13例中有10例切缘阳性。乳房X线检查仅表现为肿块的72例病例中有41例属于III组；这41例中仅有2例切缘阳性。
癌灶范围与术前组织病理学检查结果的相关性优于与乳房X线检查结果的相关性。仅包含DCIS的粗针活检，特别是乳房X线检查表现为非特异性改变或仅Ca(++)的病例，是一组在肿块切除术中存在切除不完全高风险的乳腺癌。对有这些活检结果的患者进行手术处理时，切缘应比其他情况更宽。大多数仅包含IC的粗针活检切缘阴性。
