Povoski Stephen P, Jimenez Rafael E, Wang Wenle P, Xu Ronald X
Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, 43210, USA.
BMC Cancer. 2009 Jul 27;9:254. doi: 10.1186/1471-2407-9-254.
The primary goal of breast-conserving surgery (BCS) is to completely excise the tumor and achieve "adequate" or "negative" surgical resection margins while maintaining an acceptable level of postoperative cosmetic outcome. Nevertheless, precise determination of the adequacy of BCS has long been debated. In this regard, the aim of the current paper was to describe a standardized and reproducible methodology for comprehensive and systematic assessment of surgical resection margins during BCS.
Retrospective analysis of 204 BCS procedures performed for invasive breast cancer from August 2003 to June 2007, in which patients underwent a standard BCS resection and systematic sampling of nine standardized re-resection margins (superior, superior-medial, superior-lateral, medial, lateral, inferior, inferior-medial, inferior-lateral, and deep-posterior). Multiple variables (including patient, tumor, specimen, and follow-up variables) were evaluated.
6.4% (13/204) of patients had positive BCS specimen margins (defined as tumor at inked edge of BCS specimen) and 4.4% (9/204) of patients had close margins (defined as tumor within 1 mm or less of inked edge but not at inked edge of BCS specimen). 11.8% (24/204) of patients had at least one re-resection margin containing additional disease, independent of the status of the BCS specimen margins. 7.1% (13/182) of patients with negative BCS specimen margins (defined as no tumor cells seen within 1 mm or less of inked edge of BCS specimen) had at least one re-resection margin containing additional disease. Thus, 54.2% (13/24) of patients with additional disease in a re-resection margin would not have been recognized by a standard BCS procedure alone (P < 0.001). The nine standardized resection margins represented only 26.8% of the volume of the BCS specimen and 32.6% of the surface area of the BCS specimen.
Our methodology accurately assesses the adequacy of surgical resection margins for determination of which individuals may need further resection to the affected breast in order to minimize the potential risk of local recurrence while attempting to limit the volume of additional breast tissue excised, as well as to determine which individuals are not realistically amendable to BCS and instead need a completion mastectomy to successfully remove multifocal disease.
保乳手术（BCS）的主要目标是完全切除肿瘤并实现“足够”或“阴性”的手术切缘，同时维持可接受的术后美容效果。然而，长期以来，精确确定保乳手术切缘的充分性一直存在争议。在这方面，本文的目的是描述一种标准化且可重复的方法，用于在保乳手术期间对手术切缘进行全面系统的评估。
对2003年8月至2007年6月期间为浸润性乳腺癌实施的204例保乳手术进行回顾性分析，这些患者接受了标准的保乳手术切除，并对九个标准化的再次切除切缘（上、上内侧、上外侧、内侧、外侧、下、下内侧、下外侧和后深部）进行系统取样。评估了多个变量（包括患者、肿瘤、标本和随访变量）。
6.4%（13/204）的患者保乳标本切缘阳性（定义为保乳标本墨染边缘处有肿瘤），4.4%（9/204）的患者切缘接近（定义为肿瘤距墨染边缘1毫米或以内但不在保乳标本墨染边缘处）。11.8%（24/204）的患者至少有一个再次切除切缘含有额外病变，与保乳标本切缘状态无关。保乳标本切缘阴性（定义为在保乳标本墨染边缘1毫米或以内未见肿瘤细胞）的患者中，7.1%（13/182）至少有一个再次切除切缘含有额外病变。因此，仅通过标准保乳手术，54.2%（13/24）有额外病变的再次切除切缘患者将无法被识别（P < 0.001）。九个标准化切除切缘仅占保乳标本体积的26.8%和保乳标本表面积的32.6%。
我们的方法准确评估了手术切除切缘的充分性，以确定哪些个体可能需要对患侧乳房进行进一步切除，以尽量降低局部复发的潜在风险，同时试图限制额外切除的乳房组织量，以及确定哪些个体实际上不适合保乳手术，而需要进行全乳切除以成功切除多灶性病变。
