Vincens E, Alves K, Lauratet B, Cohen S, Bakenga J, Trie A, Lefranc J-P
Service de chirurgie et de cancérologie gynécologique et mammaire, hôpital de La Pitié-Salpêtrière, Paris, France.
Bull Cancer. 2008 Dec;95(12):1155-9. doi: 10.1684/bdc.2008.0759.
For women with ductal carcinoma in situ, no residual disease after breast conserving surgery is one of the most important factors associated with local recurrence. Surgeons can rely on the pathologic examination of the margin and measure of margins width to indicate complete excision. Surgeon and pathologist have to do well and together to make margin can be assessed. Margin status is a prognostic factor for predicting residual disease. Margin width > 2 mm is associated with very few residual diseases. Margin status is also a prognostic factor for local recurrence. Local recurrence after margin width > 2-3 mm followed by radiotherapy is nearly equivalent to local recurrence after mastectomy. An evaluation based on margin status and other risk factors of recurrence (grade, necrosis, size and age like the Van Nuys Prognostic Index) can help clinicians to stratify patients into low-risk, intermediate risk and high-risk group of local recurrence. The validity of such index must be confirmed and margin width must be studied more precisely. Currently, breast conserving surgery with histological margin width > 2 mm followed by radiation therapy is necessary to obtain satisfactory local control. Such margin status with good aesthetic outcomes is not so easy to obtain with classic lumpectomy and oncologic breast surgery is a helpful technique.
对于导管原位癌女性患者，保乳手术后无残留疾病是与局部复发相关的最重要因素之一。外科医生可依靠切缘的病理检查和切缘宽度测量来指示完整切除。外科医生和病理学家必须密切合作以使切缘能够得到评估。切缘状态是预测残留疾病的一个预后因素。切缘宽度>2 mm与极少的残留疾病相关。切缘状态也是局部复发的一个预后因素。切缘宽度>2 - 3 mm后行放疗的局部复发率几乎等同于乳房切除术后的局部复发率。基于切缘状态和其他复发风险因素（如分级、坏死、大小和年龄，类似于范努伊斯预后指数）进行评估可帮助临床医生将患者分为局部复发的低风险、中风险和高风险组。此类指数的有效性必须得到证实，且切缘宽度必须进行更精确的研究。目前，切缘宽度>2 mm的保乳手术继以放射治疗对于获得满意的局部控制是必要的。通过经典肿块切除术很难获得具有良好美学效果的此类切缘状态，而肿瘤整形乳房手术是一项有用的技术。
