Campbell I D, Theaker J M, Royle G T, Coddington R, Carpenter R, Herbert A, Moore I, Rubin C, Taylor I, Guyer P B
University Surgical Unit, Southampton General Hospital.
J R Soc Med. 1991 Nov;84(11):652-6. doi: 10.1177/014107689108401108.
This study investigates the histopathological characteristics of a consecutive series of 100 screen detected breast cancers in relation to residual disease. Tumour type, size, grade, resection margins and extent of primary or associated in situ disease were all assessed by one pathologist. Thirty-seven women underwent further surgery (wider excision or mastectomy) and the resected specimen was examined for residual in situ or invasive cancer. In total, 36 cancers had an extensive in situ component, of which 69% were predominantly intraduct carcinoma of comedo type. Of the 37 women who underwent further resection, 21 (57%) women had residual cancer. Of those with initial disease at the resection margin, 16/25 (64%) had residual disease. Five of 12 (42%) with disease close to (within 2-3 mm) but not at the margin had residual disease. Of those with an extensive in situ component, 18/25 (72%) had residual disease, whereas only 2/12 (17%) women with none or some in situ disease had residual cancer. In screen detected breast cancer, residual cancer was present in 72% of women with an extensive in situ component at initial surgery. These women comprise a group in which conservation surgery may be inappropriate if completeness of excision is considered a prerequisite for breast conserving surgery.
本研究调查了连续100例经筛查发现的乳腺癌与残留疾病相关的组织病理学特征。肿瘤类型、大小、分级、切除边缘以及原位疾病的原发或相关范围均由一名病理学家进行评估。37名女性接受了进一步手术（扩大切除或乳房切除术），对切除标本进行检查以确定是否存在残留原位癌或浸润性癌。总共有36例癌症具有广泛的原位成分，其中69%主要为粉刺型导管内癌。在接受进一步切除的37名女性中，21名（57%）有残留癌。在切除边缘有初始疾病的患者中，16/25（64%）有残留疾病。在距离边缘较近（2 - 3毫米内）但不在边缘的12名患者中，5名（42%）有残留疾病。在有广泛原位成分的患者中，18/25（72%）有残留疾病，而在没有或仅有一些原位疾病的12名女性中，只有2/12（17%）有残留癌。在经筛查发现的乳腺癌中，初次手术时，72%有广泛原位成分的女性存在残留癌。如果将切除完整性视为保乳手术的前提条件，那么这些女性可能不适合进行保乳手术。
