Blair Sarah L, Thompson Kari, Rococco Joseph, Malcarne Vanessa, Beitsch Peter D, Ollila David W
University of California San Diego, Moores Cancer Center, 3855 Health Sciences Dr #0987, La Jolla, CA 92093-0987, USA.
J Am Coll Surg. 2009 Nov;209(5):608-13. doi: 10.1016/j.jamcollsurg.2009.07.026. Epub 2009 Sep 11.
The purpose of this survey was to ascertain the most common surgical practices for attaining negative (tumor-free) surgical margins in patients desiring breast-conservation treatment for breast cancer to see if a consensus exists for optimal treatment of patients.
We sent a survey to 1,000 surgeons interested in the treatment of breast cancer. Three hundred eighty-one surgeons responded to this survey and 351 were used for the analysis (response rate of 38%).
Answers showed a large variety in clinical practices among breast surgeons across the country. There was little intraoperative margin analysis; only 48% of surgeons examine the margins grossly with a pathologist and even fewer used frozen sections or imprint cytology. Decisions to reexcise specific margins varied greatly. For example, 57% of surgeons would never reexcise for a positive deep margin, but 53% would always reexcise for a positive anterior margin. Most importantly, there was a large range in answers about acceptable margins with ductal carcinoma in situ and invasive carcinoma. Fifteen percent of surgeons would accept any negative margin, 28% would accept a 1-mm negative margin, 50% would accept a 2-mm negative margin, 12% would accept a 5-mm negative margin, and 3% would accept a 10-mm negative margin.
Results of this survey highlight the wide variety of practice patterns in the US for handling surgical margins in breast-conservation treatment. This issue remains controversial, with no prevailing standard of care. Consequently, additional study is needed in the modern era of multimodality treatment to examine the minimal amount of surgical treatment necessary, in conjunction with chemotherapy and radiation, to attain adequate local control rates in breast-conservation treatment.
本次调查的目的是确定在希望接受乳腺癌保乳治疗的患者中，实现阴性（无肿瘤）手术切缘的最常见手术方法，以了解是否存在针对患者最佳治疗的共识。
我们向1000名对乳腺癌治疗感兴趣的外科医生发送了一份调查问卷。381名外科医生回复了该调查问卷，其中351名用于分析（回复率为38%）。
答案显示全国乳腺外科医生的临床实践差异很大。术中切缘分析很少；只有48%的外科医生与病理学家一起肉眼检查切缘，使用冰冻切片或印片细胞学检查的更少。重新切除特定切缘的决定差异很大。例如，57%的外科医生绝不会因深部切缘阳性而重新切除，但53%的外科医生会因前切缘阳性而总是重新切除。最重要的是，对于导管原位癌和浸润性癌的可接受切缘，答案范围很大。15%的外科医生会接受任何阴性切缘，28%会接受1毫米阴性切缘，50%会接受2毫米阴性切缘，12%会接受5毫米阴性切缘，3%会接受10毫米阴性切缘。
本次调查结果凸显了美国在保乳治疗中处理手术切缘的多种实践模式。这个问题仍然存在争议，没有普遍适用的护理标准。因此，在多模式治疗的现代时代，需要进行更多研究，以探讨在保乳治疗中结合化疗和放疗实现足够局部控制率所需的最少手术治疗量。
