Sabel Michael S, Rogers Kendra, Griffith Kent, Jagsi Reshma, Kleer Celina G, Diehl Kathleen A, Breslin Tara M, Cimmino Vincent M, Chang Alfred E, Newman Lisa A
Division of Surgical Oncology, Department of Surgery, Biostatistics Core of the University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA.
J Surg Oncol. 2009 Feb 1;99(2):99-103. doi: 10.1002/jso.21215.
While a positive margin after an attempt at breast conservation therapy (BCT) is a reason for concern, there is more controversy regarding close margins. When re-excisions are performed, there is often no residual disease in the new specimen, calling into question the need for the procedure. We sought to examine the incidence of residual disease after re-excision for close margins and to identify predictive factors that may better select patients for re-excision.
Our IRB-approved prospective breast cancer database was queried for all breast cancer patients who underwent a re-excision lumpectomy for either close or positive margins after an attempt at BCT. Close margins are defined as < or =2 mm for invasive carcinoma and < or =3 mm for DCIS. Clinicopathologic features were correlated with the presence of residual disease in the re-excision specimen.
Three hundred three patients (32%) underwent re-operation for either close (173) or positive (130) margins. Overall, 33% had residual disease identified, 42% of DCIS patients and 29% of patients with invasive disease, nearly identical to patients with positive margins. For patients with DCIS, only younger age was significantly related to residual disease. For patients with invasive cancer, only multifocality was significantly associated with residual disease (OR 3.64 [1.26-10.48]). However, patients without multifocality still had a substantial risk of residual disease.
The presence of residual disease appears equal between re-excisions for close and positive margins. No subset of patients with either DCIS or invasive cancer could be identified with a substantially lower risk of residual disease.
虽然保乳治疗（BCT）后切缘阳性令人担忧，但切缘接近的情况存在更多争议。进行再次切除时，新标本中往往没有残留疾病，这让人质疑该手术的必要性。我们试图研究因切缘接近而进行再次切除后残留疾病的发生率，并确定可能更好地选择再次切除患者的预测因素。
我们在经机构审查委员会（IRB）批准的前瞻性乳腺癌数据库中查询了所有在尝试BCT后因切缘接近或阳性而接受再次切除肿块切除术的乳腺癌患者。切缘接近定义为浸润性癌<或 =2 mm，导管原位癌（DCIS）<或 =3 mm。将临床病理特征与再次切除标本中残留疾病的存在情况进行关联。
303例患者（32%）因切缘接近（173例）或阳性（130例）而接受了再次手术。总体而言，33%的患者被发现有残留疾病，DCIS患者中有42%，浸润性疾病患者中有29%，这与切缘阳性的患者几乎相同。对于DCIS患者，只有年龄较小与残留疾病显著相关。对于浸润性癌患者，只有多灶性与残留疾病显著相关（比值比[OR] 3.64 [1.26 - 10.48]）。然而，没有多灶性的患者仍有相当大的残留疾病风险。
切缘接近和阳性的再次切除后残留疾病的发生率似乎相当。无论是DCIS还是浸润性癌患者，都无法确定残留疾病风险显著较低的亚组。
