保乳手术中用于切缘评估的术中触摸制备细胞学检查：对小叶癌是否有效？

Intraoperative touch preparation cytology for margin assessment in breast-conservation surgery: does it work for lobular carcinoma?

作者信息

Valdes Edna K, Boolbol Susan K, Ali Irfan, Feldman Sheldon M, Cohen Jean-Marc

机构信息

Department of Surgery, Louis Venet Comprehensive Breast Service, Beth Israel Medical Center, New York, New York 10003, USA.

出版信息

Ann Surg Oncol. 2007 Oct;14(10):2940-5. doi: 10.1245/s10434-007-9364-1. Epub 2007 Jul 14.

DOI:10.1245/s10434-007-9364-1

PMID:17632761

Abstract

BACKGROUND

Breast carcinoma is the most frequently diagnosed malignancy in women of the North America. The combination of breast-conservation surgery and radiotherapy has become a standard of treatment for most breast cancers. It is critical to obtain clear margins to minimize local recurrence. The literature suggests that intraoperative touch preparation cytology (IOTPC) can be useful in evaluation of margins. Invasive lobular carcinoma (ILC) accounts for 10% to 15% of all breast cancers. Obtaining clear margins in ILC can be more challenging. Literature shows the positive margin rate for ILC to be as high as 60%. This report describes our experience with IOTPC for margin assessment in ILC by a single surgeon at Beth Israel Medical Center. The purpose of this study is to determine whether IOTPC is reliable for ILC.

METHODS

A prospective review of 73 patients who underwent breast-conservation surgery with the use of IOTPC for margin assessment at Beth Israel Medical Center was performed. Pathology revealed ILC in 12 of these patients (16.4%), who are the subjects of this study. The lumpectomy specimens were oriented by the surgeon intraoperatively and were submitted fresh to pathology for cytologic assessment. IOTPC consisted of touching the corresponding margin onto the glass slide. The principle of this technique is that if cancer cells are present, they will stick to the slide, whereas fat cells will not. Six slides were prepared for each lumpectomy specimen. Air-dried samples were stained immediately by the Diff-Quik method and examined under the microscope by a cytopathologist.

RESULTS

Twelve patients with ILC underwent breast-conservation surgery with IOTPC for assessment of 72 margins. Ten patients had lobular carcinoma only, and the remaining two patients had a combination of lobular and ductal carcinoma. There was a correlation between IOTPC and final pathology in 60 of 72 margins, which accounted for 83.3% of the cases. IOTPC for assessment of margins in patients undergoing breast-conservation surgery for ILC has a sensitivity of 8.3%, specificity of 98.3%, positive predictive value of 50%, and negative predictive value of 84.3%.

CONCLUSIONS

On the basis of our experience, IOTPC is of limited value for intraoperative assessment of margins for ILC.

摘要

背景

乳腺癌是北美女性中最常被诊断出的恶性肿瘤。保乳手术与放疗相结合已成为大多数乳腺癌的标准治疗方法。获得切缘阴性以尽量减少局部复发至关重要。文献表明术中触摸准备细胞学检查（IOTPC）在切缘评估中可能有用。浸润性小叶癌（ILC）占所有乳腺癌的10%至15%。在ILC中获得切缘阴性可能更具挑战性。文献显示ILC的阳性切缘率高达60%。本报告描述了贝斯以色列医疗中心一位外科医生使用IOTPC进行ILC切缘评估的经验。本研究的目的是确定IOTPC对ILC是否可靠。

方法

对贝斯以色列医疗中心73例行保乳手术并使用IOTPC进行切缘评估的患者进行前瞻性回顾。病理检查显示其中12例患者（16.4%）为ILC，这些患者是本研究的对象。乳房肿块切除标本由外科医生在术中进行定位，并新鲜送检病理进行细胞学评估。IOTPC包括将相应的切缘触摸到载玻片上。该技术的原理是，如果存在癌细胞，它们会粘在玻片上，而脂肪细胞则不会。每个乳房肿块切除标本制备6张玻片。空气干燥的样本立即用Diff-Quik法染色，并由细胞病理学家在显微镜下检查。

结果

接受保乳手术并使用IOTPC评估72个切缘的12例ILC患者。10例患者仅患有小叶癌，其余2例患者同时患有小叶癌和导管癌。72个切缘中有60个切缘的IOTPC与最终病理结果相关，占病例的83.3%。对于接受ILC保乳手术患者的切缘评估，IOTPC的敏感性为8.3%，特异性为98.3%，阳性预测值为50%，阴性预测值为84.3%。